Wasting The Taxpayers Money – Fire and Fury Over CBT

‘The results are, at best, unreliable, and at worst manipulated to produce a positive-looking outcome’ so write the editors of the current issue of the Journal of Health Psychology, (http://journals.sagepub.com/toc/hpqa/current). They are writing in relation to a study of the efficacy of CBT for chronic fatigue syndrome ( CFS – the PACE trial). The essence of the editors’ criticism is that when objective measures of outcome were used the effectiveness of CBT disappeared, but the authors of the PACE trial relied instead on subjective self-report measures to ‘promote’ the cognitive behaviour therapy and graded exercise therapy protocols that they themselves had developed. The Times of August 1st 2017 reported a ‘trade’ of ‘insults’ between both sides.

                       PACE Trial £5 million

                                                                                           IAPT £400 million +

But the same criticism that the editors make of the evaluation of CBT for CFS can be applied to how CBT for ‘depression and anxiety’ (the alleged focus of IAPT) is evaluated in routine care in the UK Government’s IAPT Service. Evaluation is entirely based on subjective measures (the PHQ-9 and GAD-7), there is no objective measure (a standardised reliable diagnostic interview), assessment has been entirely by the service providers with no independent assessment. The cost of the PACE trial was just £5 million, a drop in the ocean compared to the cost of IAPT which saw the Coalition Government invest up to     £400 million over the four years to 2014–2015. [Department of Health (2012). IAPT Three-year Report—The First Million Patients. London: DH] .

Dr Mike Scott

 

2 thoughts to “Wasting The Taxpayers Money – Fire and Fury Over CBT”

  1. Thanks for your blog. Interesting that you are engaging with the national audit office. I know that others attempted to have them examine the problems with PACE, and the related public spending there, but that in the end the NAO decided that they should defer to the judgements of the UK medical authorities.

    The IAPT programme now includes treatments for ‘medically unexplained symptoms’ (a category no more meaningful than it sounds, that includes CFS), and it was estimated that the cost of rolling out CBT for these patients will be £200 million a year.

    I thought that you might be interested in a report from the Centre for Welfare Reform from last year. It focused on the PACE trial, but also discussed the wider problems with the political and social impact stemming from it and research like this: http://www.centreforwelfarereform.org/uploads/attachment/492/in-the-expectation-of-recovery.pdf

    “The recent drive to increase access to psychological therapies (IAPT) in the UK was funded partly because it was claimed that it would pay for itself by reducing the costs of welfare payments and increasing taxes paid by those returning to work.[140] It is not clear how many of the psychological therapies for which access has been increased are truly more effective than a well designed placebo intervention, or that providing money to these therapists is the best way of improving the opportunities of those with health problems.”

    1. This is really interesting, the quote you give is fascinating and look forward to reading the reference.
      Very best wishes

      Mike scott

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