Shifting The Focus To The Client Being Well

Conferences, government agencies such as IAPT and recent research papers, gloss over the proportion of clients who are well at the end of CBT (remission), preferring instead to talk of the number of people who have responded (response) to an intervention (proportion of people whose score reduced by greater than x%). Springer et al (2018) call for a shift in focus to the real world outcome of remission ‘remission should be the ultimate goal of treatment’. Chasteningly they point out  that the remission rate for CBT across the anxiety  disorders is just 50%.

Interestingly the results of Springer et al’s meta-analysis showed that the remission results were poorer when there was no blind evaluator. This may be important in evaluating IAPT’s performance because they have had no independent evaluator! Further the results in the Springer analysis were poorer still when there was comorbid conditions such as depression and/or subtance use disorder, suggesting that all a client’s disorders need tackling not just the primary anxiety disorder. GAD and PTSD did better than OCD and SAD with panic disorder in between.

Clients want to be well again not just reduce their score on a psychometric test that some clinician deems acceptable for their own reasons. Losing their diagnostic status should be a necessary condition  for assessing outcome, albeit that arguably it also ought to be complimented with reduction below a certain cut-off on a psychometric test.

 

Springer, K.S., Levy, H.C and Tolin, D.F (2018) Remission in CBT for adult anxiety disorders. A meta-analysis. Clinical Psychology Review, published online ahead of print

Please cite this article as: Springer, K.S., Clinical Psychology Review (2018), https://doi.org/10.1016/j.cpr.2018.03.002

Dr Mike Scott