NHS Talking Therapies boasts a 50% recovery rate. This doesn’t square, easily with the Prime Minister’s view that the NHS is ‘broken’.
A letter from Lord Darzi to the Secretary of State for Health and Social Care, dated 25 September 2024 states
‘The first step to rebuilding public trust and confidence in the NHS is to be completely honest about where it stands’. But nobody is telling the truth, that NHS Talking Therapies is performing no better than placebo. Lord Darzi in paragraph 18 of his report re-iterates NHS Talking Therapies claim of 50% recovery, with approval and without any quibble.
Marketing its’ mantra of a 50% recovery, NHS Talking Therapy has secured Government funding of £2billion a year. [Effect Size (ES) is a measure of change with an intervention]. But the published NHS Talking Therapies results show that the Effect Sizes ( i.e the difference between the post and pre-treatment scores divided by the pooled standard deviation) are no different to a placebo response. The placebo response takes account that disorders take an episodic course (i.e that symptoms naturally vary over time), and that people respond to attention, compassionate care and regression to the mean (improvement over time, first attending at their worst). Further it makes no difference whether the Service delivers alleged CBT or anything else, casting doubt on the meaningfulness of its training regime.
In the table below the Effect Size in NHS Talking Therapies for CBT (Table 4n, Annual Report 2022=2023) is contrasted with the Effect Size for placebos from the Bschor et al (2024) study.
[Extract from Bschor et al (2024) Figure 1. Random-Effects Meta-Analysis Estimates of Pooled Pre-Post Placebo Effect Sizes ]
|
Diagnosis |
Effect Size (Placebo) |
CBT Effect Sizes NHS Talking Therapies PHQ9 (GAD7) |
|
MDD |
1.40 |
1.0 (0.8) |
|
GAD |
1.23 |
0.8 (1.2) |
|
Panic disorder |
0.92 |
0.7 (1.0) |
|
PTSD |
0.84 |
0.8 (0.9) |
|
Social phobia |
0.72 |
0.8 (1.0) |
NHS Talking Therapies uses a category of ‘Anxiety’ for the biggest grouping of those receiving CBT with an ES of 0.7 on the PHQ-9, and 1.0 on the GAD-7. They thus do no better than placebo. The Service also uses a category ‘Mixed Anxiety and Depressive Disorder’ , with respective Effect Sizes of 1 (PHQ-9) and 1.1 (GAD-7), again no better than placebo. But ‘Anxiety’ and Mixed Anxiety and Depressive Disorder are not categories used in the Bschor et al (2024)study or in DSM-5-TR. Not only does NHS Talking Therapies CBT appear ineffective but the Service uses its’ own nomenclature, making comparison’s difficult.
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NHS Talking Therapies, for anxiety and depression, Annual reports, 2022-23 However, NHS Talking Therapies Categorises Its’ Treatments, There Is No Discernible Effect On Outcome The results are no different if just those at caseness (PHQ-9 score 10 or more) are considered, see table below:
Thus, it appears to make no difference to whether NHS Talking Therapies delivers alleged CBT, or whatever it delivers. Casting doubt on the meaningfulness of its’ training regime. |
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NHS Talking Therapies, for anxiety and depression, Annual reports, 2022-23
Dr Mike Scott