IAPT shouts eureka at this point, discharges the client and claims the improvement is due to the therapists efforts. It is like declaring that a person who is terminally ill is cured because they have had a good refreshing day gardening. In effect IAPT has gone fishing for flashes in the pan – I make similar points in a forthcoming BBC Radio 4 investigation into IAPT.
But studies of depression and the anxiety disorders e.g Bruce et al (2005) require a 2 month period of symptoms not significantly impairing functioning (see also DSM-5 criteria for recurrence of depression). Bruce et al (2005) point out that anxiety sufferers naturally only have symptoms 80% of the time. With regards to depression Stegenga et al (2012) point out that for 40% of depression sufferers their depression naturally takes a variable course. Without independent assessment of the period for which the person is without significant symptoms talk of remission/ recovery is meaningless. IAPT’s clients have not been assessed using this metric.
Bruce et al (2005) https://www.dropbox.com/s/9powmto8miw60a2/Natural%20recovery%20in%20Social%20Phobia%20Panic%20Disporder%20and%20Generalised%20Anxiety%20Disorder.pdf?dl=0
Stegenga et al (2012) https://www.dropbox.com/s/k0x2fm0ds01no0k/natural%20course%20of%20depression%20stegenga%202012.pdf?dl=0
Dr Mike Scott
5 replies on “When You Do Nothing, Repeated Testing Will Likely Indicate ‘Recovery’ or ‘Remission’ At Some Point”
That’s great news about the Radio 4 programme Mike. I do hope they will be discussing how MUS and LTC patients are paying the price for the IAPT service through the reductions in their physical healthcare services – mental health funding pitched against physical health funding – and how it appears that most of the MUS patients referred to IAPT will be labelled with a mental health condition (‘somatization disorder’) that they do not have.
In the MUS arm of IAPT if two scores of the relevant MUS measure aren’t collected/present then the client’s data is entered into the standard recovery calculation instead of the MUS recovery calculation.
Hopefully a paper I have co-authored with Keith Geraghty ‘ Treating Medically Unexplained Symptoms via Improving Access to Psychological Therapy (IAPT): Major Limitations Identified’ should appear before long. I did mention to Radio 4 my concerns about IAPTs expansion into MUS, but they record far more material than is broadcast so whether it finds its way into the 40 min programme I don’t know.
Thanks Mike, I’ll look forward to reading your paper. Do you know roughly when the Radio 4 programme will air? I realise there’s an awful lot to discuss about IAPT, 40 minutes really isn’t enough.
The broadcasts are as below
BBC RADIO 4
Sun 29 Sep 2019
BBC RADIO 4
Will do a blog
Thanks for the dates Mike, I’ll make sure I listen in.