All CBT Interventions Are Winners And Must Have Prizes!

This is the Alice in Wonderland take home message from IAPT workshops, BABCP conferences and CBT courses. But beyond depression and the anxiety disorders outcomes are fudged, massaged for public consumption.

At best admission to a randomised controlled trial is based on meeting the DSM criteria for the disorder. But there is no symmetry, outcome is not based on not meeting the criteria at the end of treatment. Instead dubious definitions of ‘remission’ and ‘recovery’ are used, which obfuscate whether there has been a real world change in the client’s life. It is impossible to determine whether or not they are back to their usual self.

By way of example Troscianko, in the May 2018 issue of Psychology Today, looked at CBT for bulimia, see link below:

she points out that the CBT outcome studies for bulimia use a criterion for remission as bingeing/vomiting less than twice a week for 28 days and recovery as not bingeing/vomiting for 28 days. Yet the DSM diagnosis of bulimia requires duration of the disorder of at least 3 months, transparency requires a similar period to obtain for recovery. The published results cite a 45% recovery rate but the small print indicates that this actually refers to a 28 day period. Further 30% of those who ‘recovered’ relapsed in a year, this casts doubt on the original definition of recovery. In addition the ‘positive’ findings have not been replicated by researchers independent of those who developed the protocols.

Matters become more Alice In Wonderland when studies are conducted , without the DSM criteria, for example in the case of chronic fatigue syndrome see link below

and there are prepostorous claims for success which evaporate when objective measures are used. This does not bode well for the development of an evidence base f or IAPT’s work with medically unexplained symptoms (MUS) and long term physical conditions (LTC’s). Doubtless there will be proclamations of success , but the yardsticks need to be published in advance and agreed before IAPT’s marketing exercise gets underway.

Dr Mike Scott