There is no evidence that IAPT’s psychological interventions are better than placebo and the organisation ought to be renamed Improving Access to Placebo Therapies. This calls into question the unswerving devotion of Clinical Commissioning Groups (CCG’s) and the British Association of Behavioural and Cognitive Psychotherapy (BABCP) towards IAPT.
Expectations exert a powerful influence on any psychological therapy, yet in no IAPT study or analysis of its’ own data, has there been a comparison of the IAPT intervention, with that of a group who expected to get better with a particular intervention. There is no reason to believe that IAPT’s results exceed that of a placebo.
IAPT claims to follow NICE Guidelines in delivering evidence-based treatments (ebts) for psychological disorders. But as it takes no steps to reliably identify disorder/s thus there can be no certainty that an ebt is being used that matches the debility.
GPs’ Cognitive Dispositions To Respond Promotes IAPT
Seeing a GP is a common first step along the IAPT pathway, this of itself is likely to increase expectations that something can be done about the presenting problem. The patient then invests time and energy in the said IAPT intervention, at the end of that period he/she does not want to think they have wasted their efforts. Particularly so if the therapist has been ‘nice’, there is a desire to please him/her but this does not mean that they have met criteria for recovery as defined by NICE, i.e they would no longer be eligible to enter a randomised controlled trial for the disorder from which they were originally suffering.
GP’s might be glad of the placebo effect in that it gives them a brief respite from the patient. But because a placebo does not address the mechanism involved in the generation of a disorder, difficulties are ongoing.
It is easy for GP’s to convince themselves that the IAPT interventions are making a difference because in fact, at least for the anxiety disorders, patients naturally only suffer from a condition for 80% of the time.
Thus a GP can doubtless see a post IAPT client in a good state, the vividnes of this experience (availability heuristic) then gives a mistaken impression of how likely this sequence of events is likely to be and the improvement is attributed to IAPT’s efforts (mis-attribution bias), unfortunately the next time a post IAPT patient is encountered in a good state this is seen as confirmation of their believe (confirmatory bias) in the value of the service. Such GPs may unfortunately play a major part in the CCG’s leading to the perpetuation of a failed service.
Resources
- Placebo response, Boot et al (2013) click link below: https://www.dropbox.com/s/fnmuv4t6imdcsug/Placebos%20Boot%20et%20al%202013.pdf?dl=0
- Not always got a disorder Bruce et al (2005) click link below
3. Information processing biases see link below
https://www.dropbox.com/sh/66o4qo8ru8sairz/AABxU_IeXeEcaNOqeEYBgGNOa?dl=0
Dr Mike Scott