Low Intensity CBT Is Devoid of “Intelligent Scaffolding”

As a consequence there are no protocols for Psychological Well-being Practitioners (PWPs) to follow. The scaffolding is on the back of a lorry but nobody knows what to do with it. Restoration or rebuilding is unchecked by any blueprint. There is no typology of PWP treatments. It is made up as you go along.

Consider ‘CBT for long term conditions and medically unexplained symptoms’, a book by that name has just been published [Kinsella and Moya (2022) Routledge], these authors note that their protocol isn’t deliverable within the 6 hours or less of low intensity CBT, so they suggest have just one target, say depression and with subsequent multiple referrals a comprehensive protocol can be covered! But there is no evidence that this piecemeal approach works, no evidence that such brief Behavioural Activation for depression that they recommend (nor that the entirety of the package) makes a real world difference.   

The above considerations makes IAPT’s claim  that 50% of its customers get what they want,  ‘recovery’, incredulous. The true recovery rate in IAPT is around 10% Scott (2018) https://doi.org/10.1177%2F1359105318755264 and is likely to be even less amongst those with long term conditions. Medically unexplained symptoms (MUS) is such a nebulous entity that it was dropped from the DSM. 

 

The randomised control trials of CBT for depression and the anxiety disorders, conducted before the millennium, had fidelity checks built in to ensure that clinicians were doing what they were supposed to be doing.  For each diagnosed disorder, there were specific treatments targets and matching treatment strategies. With adherence, competence and outcome assessed independently. IAPT’s mantra has been that it is compliant with these NICE approved protocols. However no fidelity check  has ever been been applied to either IAPT’s  high-intensity service or its low intensity service. 

If builders behaved in such a cavalier manner they would soon be out of business, ‘never mind about the restoration of your house, we have built you a nice bungalow’. A year ago I had published a paper ‘Ensuring IAPT Does What It Says On The Tin’ https://doi.org/10.1111/bjc.12264 but it has washed off the IAPT teflonocracy. 

Dr Mike Scott