IAPT Is Efficacious For What and By What Psychological Mechanism?

IAPT claims to be efficacious but there is no specification of for what. No treatment is universally effective, an evidence supported treatment (EST) has by definition a clearly defined focus either a disorder or a particular syndrome. There is no EST for IAPT’s fuzzy construct of ‘anxiety/depression’,  for which it claims a 50% recovery rate. IAPT’s therapists pluck an ICD-10 (World Health Organisation) code out of thin air to describe a clients functioning, but paradoxically claims that the agency does not make a diagnosis (IAPT Manual)! This process gives respectability without accountability.

A psychological therapy must work via a recognised psychological pathway, it is not sufficient that the intended target is a psychological problem/disorder (however fuzzily defined).  In not one of the 100+ missives from IAPT staff to GPs that I have seen has the mechanism of client change been clearly indicated. Rather a collection of keywords from the CBT literature is offered up, favourites in this fruit salad include, ‘reprocessing the trauma’, ‘behavioural activation’, ‘cognitive restructuring’ never is there specificity, for example ‘reversed the negative alterations in cognitions about self, others and world that led to client no longer meeting diagnostic criteria for PTSD’. Fake psychological therapies rule.

Little wonder that clients and GPs are bewildered by the IAPT process – a home for the bemused/befuddled awaits, maybe a high PHQ9 score will be the entry ticket, with promised teletherapy with an IAPT worker! 

Dr Mike Scott