Mis-Guided Self Help In IAPT

A just published study by Duhne et al (2022)found that almost a third (29%) of those assessed by the Improving Access to Psychological Therapies Service (IAPT) and referred to Guided self-help (either face to face or computer assisted CBT) did not attend any treatment sessions. Whilst of those who attended treatment over half (54%) dropped out, defined as attending three or less treatment sessions. These figures are much higher than the 20% Swift and Greenberg (2012) of clients who typically dropout of psychotherapy.

 

Curiously the authors miss the obvious implication that GSH is misguided. Instead they recommend further investigating an algorithim for better matching those who would do better in cCBT or better in face to face! Why is this? The authors declare no conflict of interest, but the Department from which it emanates at Sheffield University has a long list of IAPT teachers. There is a complete absence of critical appraisal of IAPT’s metrics suggesting that the Sheffield researchers don’t want to bite the hand of a service that gives them a ready-made data set, it eases the research burden. The Journal in which it was published Behaviour Research and Therapy characteristically ignores any criticism of IAPT.

 

Concluding anything  about the relative merits of cCBT and face to face GSH is problematic, in the Duhne et al (2022) study as the mean initial PHQ9 scores  were respectively 12.32 and 15.01, which is statistically significant p < 0.0001, when the sample sizes and standard deviations  are input into a the MedCalc comparison of means calculator.  This suggests some systematic bias in the allocation of people to these modalities. 95,088 patients accessed diverse low-intensity interventions: GSH (n = 84,503; 88.4%), psychoeducation groups (n = 8671; 9.1%), cCBT (1611; 1.7%), and other interventions (n = 753; 0.8%). 

Dr Mike Scott

Bias in CBT Journals

When the organs of communication are controlled by a single ideology we are on a short road to hell. Recently I protested to the Editor of Behavior Research and Therapy (BRAT), that no conflict of interest had been declared in a paper authored by Ali et al published in this month’s issue of the Journal, focusing on IAPT data on relapse after low intensity interventions. I pointed out that the lead author headed the Northern IAPT research network, not only did the editor ignore the conflict of interest but so to did the two reviewers, of a rejoinder to the paper that I wrote. But it is not just BRAT, IAPT sponsored papers regularly appear in Behavioural and Cognitive Psychotherapy without declarations of conflicts of interest.  I have protested to the editor about this, but again to no avail. Unfortunately it is not just a matter of what Editors of CBT Journals allow through the ‘Nothing to Declare’ aisle but also their blocking of objections to the current zeitgeist that is a cause for concern. More about this anon.

Dr Mike Scott