IAPT’s Sojourn Into The Quagmire

Putting patients with medically unexplained symptoms, such as CFS (chronic fatigue sundrome) and IBS (irritable bowel syndrone) on a mental health pathway, is a fraught endeavour, can there be any certainty that physical investigations of their difficulty will continue? Who will provide that certainty, surely not IAPT( Improving Access to Psychological Therapies) workers? Perhaps GP’s or gastroenterologists – doubtful?

 IAPT’s focus is on psychological interventions, most patients with long term physical conditions will find it incongruous to be offered a mental health intervention, unless there is a clear additional problem such as panic disorder. There is a danger that those with LTC’s will feel the normal emotional distress associated with their long standing problem is being psycho-pathologised.  

Whilst some with LTC’s may wish to avail themselves of psychological help, many will do so at the behest of a GP or gastronetrologist, believing that they would not be suggesting it, if it were not evidence based. Yet there is in fact a weak evidence base for CBT for these conditions compared to that which obtains for the anxiety disorders and depression.

Psychological interventions in the LTC area serve to distract from improving the poor quality services in areas in which CBT could make a real world difference. Rather they have a novelty value and attract funding/empire building.

Dr Mike Scott

We Need a ‘Cochrane’ To Evaluate Routine Practice

Cochrane reviews are often used as a ‘gold standard’ for establishing whether a treatment can be regarded as efficacious. They are independent of practitioners/researchers. But they don’t always get it right, for example on the appropriateness of graded exercise for chronic fatigue syndrome (CFS). Nevertheless there is a re-consideration of conclusions in the the light of the critique of others and they are for example going to post a qualifying note about their original conclusions on CFS. Whilst others including myself would wish that their original report was withdrawn, nevertheless one feels that there is an openness and objectivity. By contrast when it comes to evaluating whether treatments are effective in routine practice, as in IAPT, there is no such ‘Cochrane’, it feels much more like voicing dissent in some totalitarian regime. Those in power dominate the media, refuse to directly and openly debate and the juggernaut roles on, until one day it will implode and people will wonder why the writing on the wall was not heeded earlier!

Dr Mike Scott

Subjective Measures Are Insufficient – Lessons from CBT for ME/CFS

The  results of the PACE trial of CBT plus graded exercise for CFS have just been confirmed by a review of 5 Dutch studies

https://www.researchgate.net/publication/322956569_An_analysis_of_Dutch_hallmark_studies_confirms_the_outcome_of_the_PACE_trial_cognitive_behaviour_therapy_with_a_graded_activity_protocol_is_not_effective_for_chronic_fatigue_syndrome_and_Myalgic_Encep , the author’s concluded ‘ Improvements on subjective measures (self-report questionnaires), which are sensitive to placebo effects, response bias, buy-in effects and other psychological effects , isn’t reflected by an improvement in objective measures’. This was illustrated by the finding that 32% of the patients in the non-intervention group reported clinically significant improvement afterwards.

 

IAPT justifies itself wholly in terms of changes on psychometric tests, alleging a 50% recovery. However there has been no independent examination to determine the proportion totally free of symptoms by the end of treatment. My own work in fact suggests just a 10% recovery,https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0 . In mid July the Journal of Health Psychology is publishing an Open Access Special Issue ‘IAPT Under the Microscope’ in which these issues are explored further, with 4 contributors, including myself and a missive from the Editor, Dr David Marks.

 

Dr Mike Scott

House of Lords – Expansion of IAPT into ME Despite Not Knowing How Such Clients Have Already Fared In The Service!

Chronic Fatigue Syndrome: Written question – HL7468

Asked by The Countess of Mar
Asked on: 01 May 2018

Department of Health and Social Care
Chronic Fatigue Syndrome

HL7468
To ask Her Majesty’s Government what are the recovery rates of patients with myalgic encephalomyelitis who have received treatment under the Improving Access to Psychological Therapies programme.

Answered by: Lord O’Shaughnessy
Answered on: 15 May 2018

This information is not available

 

 

Whatever happened to evidence based CBT?

 

Dr Mike Scott