In IAPT, CBT No Better Than Counselling

a study of IAPT data, by Barkham and Stone (2018), published in BMC Psychiatry, (see link below), shows high intensity CBT is no better than high intensity counselling. The authors note that this finding runs counter to NICE Guidance and they might have added to the specific superiority of CBT found for particular disorders, see Tolin et al (2015) [ link below]. This makes the whole IAPT database and its customary analysis suspect. Whatever the intervention Barkham and Stone (2018) found a 6 point reduction on the mean PHQ9 score of 15. Such a reduction one would expect with time and any ‘credible’ attention treatment.

Interestingly the Barkham and Stone (2018) study found low intensity CBT did not enhance performance of any high intensity intervention. The case for low intensity interventions appears to be built on sand. There was no evidence in this study that there were meaningful distinctions between CBT and counselling (i.e no fidelity checks) and no evidence of fidelity to an evidence based treatment protocol. Fidelity checks are impossible without the reliable diagnosis IAPT eskews.

The Barkham and Stone (2018) study lays bare the many fault lines in IAPT, the tremors can be felt when will the earthquake occur?

Dr Mike Scott