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