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BABCP Response - NICE Consultation January 2022

Use of Blinded Clinical Assessment Halves Claimed Remission Rate – Casting Serious Doubts on NHS Talking Therapies Justification

 

The received mantra of NHS Talking Therapies is that 50% [ IAPT Manual (2019)] of its’ clientele recover. This is the basis for the £1billion a year funding of the service. But the small print states that that the claim is based on clients who completed a self-report measure at their last contact and had attended 2 or more treatment sessions. A just published study by Pigott et al (2023) shows the spin to be had from relying on a self-report outcome measure. These authors re-analysed outcome data on the efficacy of antidepressants. It was initially reported that the average remission rate was 48.4%, but Pigott et al (2023) pointed out that that this was based on the clinic-administered Quick Inventory of Depressive Symptomatology-Self-report, despite stating in the pre-trial protocol that all such measures would be excluded. The results of a blind independent assessment (the clinician Hamilton Rating Scale for depression) went unreported, but revealed a 25.5% recovery rate! The results for NHS Talking Therapies and antidepressants are likely no better than if a client was given attention and a credible rationale as to how to emerge from their chaos. In routine practice there is nothing to indicate that responses to therapeutic endeavours are any greater than placebo. Neither, the  NHS Talking Therapies data nor the STAR*D data [Pigott et al (2023)] have involved a control condition. Nevertheless, the hype has continued, on November 8th 2022 the New York Times reported that ‘nearly 70% of people had become symptom free by the fourth antidepressant”’. Interestingly the dropout rate in the Star*D trial was 53.7%, much the same percentage as those who did not complete treatment in NHS Talking Therapies. With regards to NHS Taling Therapies there is no evidence of treatment integrity – a translation of the protocols of randomised controlled trials for CBT to routine practice.

 

Dr Mike Scott

7 replies on “Use of Blinded Clinical Assessment Halves Claimed Remission Rate – Casting Serious Doubts on NHS Talking Therapies Justification”

I am a counsellor who has tried to use IAPT/TALKING THERAPIES and find the can’t even get basics right, poor access etc. One therapist I saw was “accredited counsellor and supervisor”, I left feeling I had done a six week monologue. When doing my degree I used one of her supervisees and found the none accredited person far superior.

My repeated experience of IAPT has been that when things have gone seriously wrong causing either me or the therapist to end the sessions the questionnaires have immediately stopped along with any interest in how I was doing subsequently.

I kept drawing analogies with IAPT while watching ‘Painkiller’. The focus on hype and overselling from senior levels with very little integrity.

Fascinating to learn after my fourth discharge that “Baron” Layard—Old Etonian, LSE workfare wonk and Blairite happiness guru—the intellectual father of IAPT—was also in 1990s one of the Western advisors who set USSR on the road to, er, capitalist prosperity. You have to see the funny side!

The hype is quite unbelievable Kojay. One of the sponsors of an NHS Talking Therapies meet on Oct 19th is SilverCloud who claim there platform is ‘clinically proven to be as effective as face to face therapy’. But none of the research papers they cite actually demonstrate this. The said meeting is about digital therapies, but here we have a great overselling. It is indeed reminiscent of a Marxist colleague of mine extolling the virtues East Germany when under USSR domination. It is the same idea that there are cheap simple solutions to the human predicament, a quick glance at the Lucy Letby and Malkinson cases suggests otherwise.

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