A Critical Transatlantic Take on IAPT

Dr David Tuller from the University of Berkeley, California has penned a very critical blog on IAPT  http://www.virology.ws/2020/01/15/trial-by-error-cbt-provides-no-benefits-to-advanced-cancer-patients-study-finds/

two years ago he was one of the authors of a reanalysis of the PACE trial data on the efficacy of CBT for chronic fatigue syndrome and essentially found the data had been fudged.

Dr Mike Scott

Subjective Measures Are Insufficient – Lessons from CBT for ME/CFS

The  results of the PACE trial of CBT plus graded exercise for CFS have just been confirmed by a review of 5 Dutch studies

https://www.researchgate.net/publication/322956569_An_analysis_of_Dutch_hallmark_studies_confirms_the_outcome_of_the_PACE_trial_cognitive_behaviour_therapy_with_a_graded_activity_protocol_is_not_effective_for_chronic_fatigue_syndrome_and_Myalgic_Encep , the author’s concluded ‘ Improvements on subjective measures (self-report questionnaires), which are sensitive to placebo effects, response bias, buy-in effects and other psychological effects , isn’t reflected by an improvement in objective measures’. This was illustrated by the finding that 32% of the patients in the non-intervention group reported clinically significant improvement afterwards.

 

IAPT justifies itself wholly in terms of changes on psychometric tests, alleging a 50% recovery. However there has been no independent examination to determine the proportion totally free of symptoms by the end of treatment. My own work in fact suggests just a 10% recovery,https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0 . In mid July the Journal of Health Psychology is publishing an Open Access Special Issue ‘IAPT Under the Microscope’ in which these issues are explored further, with 4 contributors, including myself and a missive from the Editor, Dr David Marks.

 

Dr Mike Scott

Wasting The Taxpayers Money – Fire and Fury Over CBT

‘The results are, at best, unreliable, and at worst manipulated to produce a positive-looking outcome’ so write the editors of the current issue of the Journal of Health Psychology, (http://journals.sagepub.com/toc/hpqa/current). They are writing in relation to a study of the efficacy of CBT for chronic fatigue syndrome ( CFS – the PACE trial). The essence of the editors’ criticism is that when objective measures of outcome were used the effectiveness of CBT disappeared, but the authors of the PACE trial relied instead on subjective self-report measures to ‘promote’ the cognitive behaviour therapy and graded exercise therapy protocols that they themselves had developed. The Times of August 1st 2017 reported a ‘trade’ of ‘insults’ between both sides.

                       PACE Trial £5 million

                                                                                           IAPT £400 million +

But the same criticism that the editors make of the evaluation of CBT for CFS can be applied to how CBT for ‘depression and anxiety’ (the alleged focus of IAPT) is evaluated in routine care in the UK Government’s IAPT Service. Evaluation is entirely based on subjective measures (the PHQ-9 and GAD-7), there is no objective measure (a standardised reliable diagnostic interview), assessment has been entirely by the service providers with no independent assessment. The cost of the PACE trial was just £5 million, a drop in the ocean compared to the cost of IAPT which saw the Coalition Government invest up to     £400 million over the four years to 2014–2015. [Department of Health (2012). IAPT Three-year Report—The First Million Patients. London: DH] .

Dr Mike Scott