Improvements on the PHQ-9 and GAD-7 are the metrics that the Service uses to justify its’ effectiveness. But data from a study by Graham et al (2020), shown below, reveal the changes in both these measures on a waiting list i.e simply with the passage of time:
| Time | PHQ-9 | GAD-7 |
| Baseline | 13.6(5.2)) | 11.2(4.7) |
| Week 4 | 11.9(5.6) | 10.7(5.2) |
| Week 8 | 11.4(6.6) | 9.8(5.5) |
| Week 12 | 8.0(5.9) | 7.0(4.5) |
| Week 16 | 7.0(5.4) | 6.0(4.8) |
Inspection of NHS Talking Therapies Data for 2022-2023
reveals the following changes on the PHQ-9 and GAD-7 from the beginning to end of treatment (for those initially at a casenness level):
| PHQ-9 | GAD-7 | ||
| Beginning treatment | 15.4(5.5) | 14(4.5) | |
| End treatment | 9.4(6.4) | 8.4(5.7) |
These results are not discernibly different to those on Graham et al’s 2020) waiting list! No added value for ‘psychological treatment’ has been demonstrated. Importantly there is no evidence that NHS Talking Therapies ministrations make an enduring difference to client’s lives.
According to the IAPT (NHS Talking Therapies predecessor) Manual – a reduction of 6 or more on the PHQ-9 and a reduction of 4 or more on the GAD-7 is taken as clinically meaningful improvement. If the person has reduced to below 10 on the PHQ-9 and below 8 on the GAD-7 they are deemed to have recovered. Thus judged by NHS Talking Therapies yardstick those on Graham et al’s 2020) waiting list are an unbridled success! There is clearly something very misleading about the Service’s use of the PHQ-9/GAD-7 metric.
Why then is the UK Government spending £2billion a year on Adult and Child NHS Talking Therapies.
Dr Mike Scott
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