IAPT’s The Solution, So What Is The Problem?

IAPT specialises in poorly defined problems, making it easy to claim success. Good marketing ensures its’ claims are taken on board by politicians and NHS decision makers. None of the problems it addresses have been as sharply defined as necessitated in the randomised controlled trials of CBT. Dealing in fuzzy problems leads to trading in fuzzy outcomes.

This fuzziness makes it easier for practitioners to convince themselves they are doing a good job. For example remembering in graphic detail a case that worked and ignoring the many failures (the operation of the availability heuristic). But it all begins to lack credibility when there are high levels of burnout (68% in low intensity and 50% in high intensity) and a 22% annual staff turnover in low intensity. In addition some staff are subjected to league tables, incentivised to perform better by the promise of extra holidays and told to limit sessions to six.

IAPT’s original remit was depression and the anxiety disorders, but these terms had a very specific meaning in the rct’s. The boundaries of these disorders were defined by what Aaron Beck termed controlling for information variance (the range of symptoms considered pertinent for a particular disorder) and criterion variance (whether a symptom was present at a level that constituted impairment) as gauged by a standardised diagnostic interview. Neither type of variance has been addressed by IAPT, instead it has developed its own fundamentalist definition of what anxiety and depression are, eskewing reliable diagnosis. IAPT’s fuzziness has reached a new level as it extends its’ scope to medically unexplained symptoms, despite the injunction from DSM5 that just because something is medically unexplained that is not sufficient basis for saying that it is psychological.

IAPT marches ever on, perhaps it can ‘solve’ BREXIT

Dr Mike Scott