so challenge Clinical Commissioning Groups on the value for money – no better than homeopathy. Studies of CBT for long term conditions (LTCs) show either no effect, see Serfaty et al study (2019) on cancer https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/effectiveness-of-cognitivebehavioural-therapy-for-depression-in-advanced-cancer-cantalk-randomised-controlled-trial/E9264C516634EC7BC3FF9E80B551A8C5
and/or rely on a self report measure of questionable real world significance, see the Everitt et al (2019) study of irritable bowel syndrome https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30243-2/fulltext In the Everitt et al (2019) study outcome was assessed primarily by the patient’s completion of a 5 item measure of the severity of IBS (IBS-SSS) rather than a clinician independent of the study asking the IBS-Adequate Relief question ‘ since… have you had adequate relief of your IBS’. Usually the IBS-AR uses the time frame of the past seven days but in the context of assessing CBT it could be since entering the study for a control group or since cbt for those having cbt. The correlation between the IBS-AR and IBS-SSS though significant is small see Passos et al (2009) http://nrs.harvard.edu/urn-3:HUL.InstRepos:35859644
The authors of the Everitt et al (2019) study appear not to realise that use of a self-report measure as the primary outcome measure introduces a demand effect for clients undergoing cbt, they don’t want to feel that they have wasted their time. Further the Passos et al (2009) study showed that the IBS-AR is much less subject to fluctuation than the IBS-SSS. Arguably the IBS-AR is of much greater social significance, addressing whether an intervention makes a real world difference.
It is worrying that Everitt et al (2019) opine:
‘Offering both web-CBT and telephone-CBT in NHS services such as Improving Access to Psychological Therapy could allow many patients to gain substantial benefits with web-CBT with minimal therapist input while allowing a step-up approach to telephone-CBT for those needing additional
support’
IAPT will surely jump on this to justify empire building and likely ignore the caution of Serfaty et al (2019)
‘our results suggest that resources for a relatively costly therapy such as IAPT-delivered CBT should not be considered as a first-line treatment for depression in advanced cancer. Indeed, these findings raise important questions about the need to further evaluate the use of IAPT for people with comorbid severe illness’
If as seems likely Clinical Commisioning Groups fund IAPT’s expansion into LTCs they should be asked to justify this expenditure in the abscence of any empirical base.
Dr Mike Scott
