What Is The Simplest Explanation of How Clients Fare In The Improving Access to Psychological Therapies Service?

 

The philosophical principle of Occam’s Razor suggests that the simplest explanations are usually the correct one. Most will present to IAPT at their worst and there will be some improvement with the passage of time and attention. But clients could just as easily have benefitted from attending the Citizens Advice Bureaux,  i.e there is no added benefit from IAPT. Last year over a third (38%) of those who accessed the IAPT service attended one or less treatment session, and it is unlikely that they would benefit from such a sub-therapeutic dose of therapy.  The suspicion is therefore that IAPT doesn’t work. If one tries to explain the therapeutic gains of defaulters (defined by IAPT as attending less than 2 treatment sessions) from the Service, complexity enters. The confusion is not lessened when one tries to explain how it is that completer’s attending on average of 7.5 sessions, apparently make gains comparable to those in randomised controlled trials, with just half the number of sessions! IAPT’s claims beggar belief.

CBT is allegedly ubiquitous in the Improving Access to Psychological Therapies (IAPT) service. Overall a 50% recovery rate is claimed. How then is it effective with one out of two completers of treatment but also ineffective with one out of two? We enter the black hole again.

It is axiomatic amongst CBT adherents that negative cognitions and avoidance behaviours perpetuate negative emotional states. It is further assumed that targeting these maintaining agents will resolve the negative emotional state. But this latter scenario will only unfold if the negative cognitions and avoidance behaviours are pivotal in the onset of the negative emotional state. If a person is suffering from, say chronic fatigue syndrome the salience of negative cognitions and avoidance behaviours may be questionable. The biopsychosocial model of CFS advanced by Deary et al 2007 is of such complexity, that no aetiological agent e.g child neglect, could be ruled out. Applying Occam’s Razor the likelihood is that a primary physical basis for CFS will be found or that it actually covers a range of disorders each with a different biological base. 

In the case of depression negative life events and neuroticism are strong predictors. But neuroticism could be the driver for negative cognitions and avoidance behaviours. However neuroticism itself maybe a product of a particular style of engaging in mental time travel, in which negative events are given a particular salience and homage is paid to them with avoidance behaviour. It is scarcely credible that 7-8 sessions of CBT therapy will nullify the effects of neuroticism/mental time travel for a period that the client would see as clinically meaningful e.g 8 weeks.

Dr Mike Scott