Categories
BABCP Response - NICE Consultation January 2022

All Therapies Are Equal and Must Have Prizes?

A just published paper in the Journal of Clinical Psychology by Smith and Hewit (2024) proclaims the equivalence of psychodynamic and cognitive behavioural therapy for depressive disorder in adults. At face value it supports the Dodo verdict – that all psychotherapies are equal and it is the common factors between them that makes a difference. But the authors appear to be operating in a parallel universe:

  1. It is impossible to discern from the 10 studies considered what proportion of people in each condition were recovered in the sense that they considered themselves back to their old selves and the duration of such a return.
  2. Only 4 of the 10 studies used independent blind-raters.
  3. Patients had 22-25 treatment sessions, this impossible to provide in routine practice, but this is not even mentioned
  4. Only the results on completers could be furnished, no intention to treat analysis.
  5. Only 4 of the 10 studies assessed treatment adherence.
  6. The authors observe ‘ The HRSD was the most commonly used measure of depressive symptoms across included studies. However, research suggests that the HRSD’s total score is multidimensional, that its factor structure is not invariant across different populations, and that its conceptualization of depression is several decades out of date (see Bagby et al., 2004 for review). Hence, future research would likely profit from using a more psychometrically sound assessor‐rated measure of depression’
  7. 75% of the population was female, no report of social class. 4 studies did not report ethnicity.

Real-world avoidance is it seems ripe

 

Dr Mike Scott

Categories
BABCP Response - NICE Consultation January 2022

In IAPT, CBT No Better Than Counselling

a study of IAPT data, by Barkham and Stone (2018), published in BMC Psychiatry, (see link below), shows high intensity CBT is no better than high intensity counselling. The authors note that this finding runs counter to NICE Guidance and they might have added to the specific superiority of CBT found for particular disorders, see Tolin et al (2015) [ link below]. This makes the whole IAPT database and its customary analysis suspect. Whatever the intervention Barkham and Stone (2018) found a 6 point reduction on the mean PHQ9 score of 15. Such a reduction one would expect with time and any ‘credible’ attention treatment.

Interestingly the Barkham and Stone (2018) study found low intensity CBT did not enhance performance of any high intensity intervention. The case for low intensity interventions appears to be built on sand. There was no evidence in this study that there were meaningful distinctions between CBT and counselling (i.e no fidelity checks) and no evidence of fidelity to an evidence based treatment protocol. Fidelity checks are impossible without the reliable diagnosis IAPT eskews.

The Barkham and Stone (2018) study lays bare the many fault lines in IAPT, the tremors can be felt when will the earthquake occur?

https://www.dropbox.com/s/0smsyusnobi6tnm/IAPT%20Barkham%20and%20Saxon%202018%20dodo%20verdict.pdf?dl=0

https://www.dropbox.com/s/r3bja27takbicnc/Tolin%202015%20Dodo.pdf?dl=0

Dr Mike Scott