Low Intensity CBT Works ‘Just like That’

as the magician Tommy Cooper would have said. The Improving Access to Psychological Therapies Service (IAPT) invites its’ paymasters Clinical Commissioning Groups (CCGs)/NHS England to fund a simple and cheap solution to mental health problems. If it sounds too good to be true, it probably is. But this hasn’t stopped IAPT becoming the over a £1bn a year magnet for investment and all without independent assessment.

Here is an extract from a Psychological Wellbeing Practitioner’s (PWP) letter to a GP:

Stress Control Course undertaken outcome was successful evidenced by the first and last questionnaire

 

PHQ9

GAD7

Nov 2018

6

12

Jan 2019

1

5

The PWP is unaware that a score on a psychometric test is not an evidence-based construct. Such scores are not specific to anything. They cannot be used as a surrogate for a diagnosis.  ‘Stress’ is a fuzzy, the terms usage in this context, resembles Alice in Wonderland where words mean whatever you want them to mean.  Further, a change in the score is not evidence that the person’s needs have been met.

The mechanism’s of action in the original randomised controlled trials of CBT for depression and the anxiety disorders were clearly stipulated. As were outcomes e.g loss of diagnostic status as assessed by independent clinicians. But in the low intensity interventions there is no specification of an evidence-based mechanism for change. In effect we are invited to believe in the magic, it works just like described in the letter abstract. One can only gasp at the incredulity of CCGs and wonder what agenda they are working on. But the British Association for Behavioural and Cognitive Psychotherapy (BABCP), the ‘Lead’ organisation for CBT practitioners has a special section for PWPs and IAPT rejoices that its’ low intensity CBT courses are validated by the British Psychological Society. They have failed clients abysmally. 

Dr Mike Scott