CBT Watch - blog

Hutan

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An active blog focused on claims relating to CBT and IAPT, by Dr Mike Scott.
http://www.cbtwatch.com

It describes itself as 'An Independent Mental Health Watchdog and Discussion Forum'
The casualties of our mental health system are varied, examples detailed on this blog include: a mother who has been and continues to be denied access to her 3 children because of an unfounded diagnosis of a personality disorder and the plight of CBT practitioners, one half of whom believe that they are depressed. This site could be like a Field Hospital offering succour to all those in need but who are also protesting about the ‘war/failed system’.

It's not anti-CBT, but is anti-IAPT. There's a lot of well referenced material there that is likely to be of interest to those concerned about IAPT.


From the 24 Feb 2021 blog 'IAPT: Suicidal and give online CBT'
Oftentimes a client with thoughts that they would be ‘better off dead’ are passed back to their GP. The GP is then obliged to contact the patient to discover that the ‘suicidal thoughts’ are most often passive and without any active intent or planning. In such instances IAPT had not taken the time to discover whether there was any active planning of suicide. The reaction of the Organisation is that ‘we do not want egg on our face’, so bounce it back to the GP. Unfortunately GP’s don’t complain to their Clinical Commissioning Groups about IAPT, content that they get a break from these ‘non-medical’ cases whilst they are being seen by IAPT, albeit that it is a revolving door.


From the 17 Feb 2021 blog 'IAPT fails to rebut charge of a tip of the iceberg rate of recovery'
The British Government is looking at the matter of making NHS England accountable, to date the latter has allowed IAPT to mark its’ homework, with no involvement of the Care Quality Commission. Having spent over £4billion on IAPT the time for change is long overdue.

Kellett et al (2021) claim that it would be too expensive to have a high quality, ‘gold standard’ effectiveness study with independent blind assessors using a standardised semi-structured diagnostic interview. But set against the £4billion already spent on the service over the last decade the cost would be trivial. It is perfectly feasible to take a representative sample of IAPT clients and conduct independent blind assessments of outcome that mirror the initial assessment.

Indeed the first steps in this direction have already been taken in an evaluation of internet CBT [ Richards et al (2020)] in which IAPT Psychological Wellbeing Practitioners used the MINI [ Sheehan et al (1998)] semi-structured interview to evaluate outcome, albeit that they were not independent evaluators and there could be no certainty that they had not used the interview as a symptom checklist rather than in the way it is intended. Further the authors of Richards et al (2020) were employees of the owners of the software package or worked for IAPT.

Tolin et al (2015) have pointed out that for a treatment to be regarded as evidence-supported there must be at least two studies demonstrating effectiveness in real world settings by researchers not involved in the original development and evaluation of the protocol and without allegiance to the protocol. Kellet et al (2020) have failed to explain why IAPT should not be subject to independent rigorous scrutiny and their claim that their own work should suffice is difficult to understand.
 
Mike Scott is not anti CBT. He has written several books on the subject. He is critical, as I am, of how the IAPT project is panning out. For example, lack of evidence based assessments, poor quality evidence for the low intensity interventions (the majority of work carried out within IAPT ) and so forth And especially the move to hoover up "MUS" and LTC where there is no evidence base and the potential for harms is pretty obvious
 
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She proclaims “It is now commonly accepted that CBT ‘works’ to a greater or lesser extent for most physical health conditions”
Yes, people who believe in a thing, accept that thing. Homeopaths commonly accept that homeopathy 'works', to a greater or less extent. This is basically the definition of something being fashionable. Because everything is projection in this ideology, so is the idea of fashionable diagnoses. Which come strictly from psychosomatic ideologues, not the patients.

This is the not the basis for anything. In fact accepting this standard is a complete perversion of everything science taught us. Every damn pseudoscience out there is "accepted" by its proponents. Every false paradigm and all fraudulent claims shared the feature of being "accepted" by people who believe in it. This very idea was accepted for asthma, peptic ulcers and many other conditions before the charlatans were chased away by science shining on the right answer.

Psychology has invaded this space and owns it already, we know the outcome of this paradigm because this is what existed already when LC came along. The entire basis of separating the concept away from immunology was to make it fully generic. By the definitions used for decades in the field, everything they have done so far should apply to Long Covid, there is no basis to investigate anything specific, the concept generically applies to any and all "fatigue" or generically to "symptoms", whatever is meant by that.

To admit otherwise, to claim that this needs to be researched and re-applied all over again is an admission of fraud, of having fraudulently sold a lie by claiming it is fully generic and applies in all cases. The fact that the ideology is fully generic is one of its main features. As Simon Wessely said, the biology is as relevant here as the color of the car that injured a patient heading to emergency care. This was a positive affirmation, not some passing mention, it is core to the ideology.

But of course since the entire concept is a Big Lie, no one will care. Just as no one actually cared that for years the CODES trial researchers insisted that only the objective outcome of number of seizures mattered, then when this failed they immediately pretended they never said that. This failed trial is still considered "impressive", because failure is expected and no one actually cares since failure and success have no formal meaning here.

As with all forms of rampant cheating, it's not the cheating, or the cheaters who are to blame, it's the existence of an accepted culture of systematic fraud. It's the failures that enable the cheating, that reward cheaters and enable not just a culture where cheating is accepted, but where it is necessary, since everyone cheats, those who don't are left behind with nothing to show.

Some... Norwegian, I think, doctor posed that question on Twitter the other day, about why pwME reject the role of psychology when it's commonly used in cancer. The responses were solid and refuted his point entirely, that cancer patients aren't sent to therapy where they are told it's their thoughts that make them ill and that they don't actually have cancer, only think they do. Well, not anymore anyway. That no one actually objects to it, it's the false claims and fraudulent methods that people object to. He hasn't replied yet, the answers do not fit the caricature he expects.

A system built on lies is a system designed to fail. A system designed to fail does not deserve to keep existing, it must be replaced.
 
And especially the move to hoover up "MUS" and LTC where there is no evidence base and the potential for harms is pretty obvious

Whatever the intention behind recommending CBT for all Long Term Conditions and Medically Unexplained Symptoms (it's very good for psych careers, perhaps?), I think the most likely result is causing extreme poverty amongst people on benefits because anyone deemed to have a psychological problem is also deemed to be able to get well with CBT and exercise, so benefits are reduced to such a level as to make survival impossible . And for people who have paid into medical insurance policies their benefits will get cut off after 18 - 24 months if their chronic disease is assumed to be psychological in origin.

Edit : Grammar
 
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All only possible because of the mental health exclusion. You know, since they can't tell if you're faking mental illness. Or what mental illness even is, or how to define it other than its more superficial outward behavioral features. And have gotten this algorithm wrong literally millions of times in the past, present and ongoing future.

But they can totally tell when your mental illness is the actual cause of your physical complaints. They just know it, no need to check. Some people who may or may not have anything remotely similar to what you are experiencing answered ambiguous questions on biased questionnaires that can be interpreted in some ways, and that means, well, the magic is that it literally anything the person doing the interpretation wants it to mean. It's like in outer space, there is no up or down, it's only as you define it.

Of course that's because the idea is that mental illness is the patient's responsibility, by default of waiving any legal responsibility through "de-medicalization". Just like that, the absence of any obligation becomes the patient's sole responsibility. What a happy coincidence that it's only ever talked about as a cost-saving measure. Happy for the bank accounts of some people anyway.
 
No treatments for FM "work" so let's just throw CBT paint on the wall and interpret the splotches.

That's the gist of most so-called research or review articles about FM, and I suspect about ME and a peck of other diagnoses.

Sure, if you're down on yourself, get the gist of the negative thinking principles and use them to stay out of depression.

But the pain is still there. Still there. Still there.
 
Yes, people who believe in a thing, accept that thing. Homeopaths commonly accept that homeopathy 'works', to a greater or less extent. This is basically the definition of something being fashionable. Because everything is projection in this ideology, so is the idea of fashionable diagnoses. Which come strictly from psychosomatic ideologues, not the patients.

This is the not the basis for anything. In fact accepting this standard is a complete perversion of everything science taught us. Every damn pseudoscience out there is "accepted" by its proponents. Every false paradigm and all fraudulent claims shared the feature of being "accepted" by people who believe in it. This very idea was accepted for asthma, peptic ulcers and many other conditions before the charlatans were chased away by science shining on the right answer.

Psychology has invaded this space and owns it already, we know the outcome of this paradigm because this is what existed already when LC came along. The entire basis of separating the concept away from immunology was to make it fully generic. By the definitions used for decades in the field, everything they have done so far should apply to Long Covid, there is no basis to investigate anything specific, the concept generically applies to any and all "fatigue" or generically to "symptoms", whatever is meant by that.

To admit otherwise, to claim that this needs to be researched and re-applied all over again is an admission of fraud, of having fraudulently sold a lie by claiming it is fully generic and applies in all cases. The fact that the ideology is fully generic is one of its main features. As Simon Wessely said, the biology is as relevant here as the color of the car that injured a patient heading to emergency care. This was a positive affirmation, not some passing mention, it is core to the ideology.

But of course since the entire concept is a Big Lie, no one will care. Just as no one actually cared that for years the CODES trial researchers insisted that only the objective outcome of number of seizures mattered, then when this failed they immediately pretended they never said that. This failed trial is still considered "impressive", because failure is expected and no one actually cares since failure and success have no formal meaning here.

As with all forms of rampant cheating, it's not the cheating, or the cheaters who are to blame, it's the existence of an accepted culture of systematic fraud. It's the failures that enable the cheating, that reward cheaters and enable not just a culture where cheating is accepted, but where it is necessary, since everyone cheats, those who don't are left behind with nothing to show.

Some... Norwegian, I think, doctor posed that question on Twitter the other day, about why pwME reject the role of psychology when it's commonly used in cancer. The responses were solid and refuted his point entirely, that cancer patients aren't sent to therapy where they are told it's their thoughts that make them ill and that they don't actually have cancer, only think they do. Well, not anymore anyway. That no one actually objects to it, it's the false claims and fraudulent methods that people object to. He hasn't replied yet, the answers do not fit the caricature he expects.

A system built on lies is a system designed to fail. A system designed to fail does not deserve to keep existing, it must be replaced.

Yep it means nothing - especially if it isn't true AKA for a scientist I don't see her presenting research on that, even if it means nothing anyway.

Other than..... it being a tactic to close down debate AKA 'it is now commonly accepted bla bla bla..' = 'I don't want to hear about anything to the contrary'. Worrisome for someone who is supposed to be in science. Did she not have to learn about copernicus in her physics A level (if she did it) or do a module on history of science or themes and debates in her Psychology degree to know that so many things that are 'dead ends' get pushed by that exact phrase/hegemony? Because those were the aspects of those course that made them science along with research design and understanding limitations of your experiment along with how to form hypotheses that can be properly tested?
 
All only possible because of the mental health exclusion. You know, since they can't tell if you're faking mental illness. Or what mental illness even is, or how to define it other than its more superficial outward behavioral features. And have gotten this algorithm wrong literally millions of times in the past, present and ongoing future.

But they can totally tell when your mental illness is the actual cause of your physical complaints. They just know it, no need to check. Some people who may or may not have anything remotely similar to what you are experiencing answered ambiguous questions on biased questionnaires that can be interpreted in some ways, and that means, well, the magic is that it literally anything the person doing the interpretation wants it to mean. It's like in outer space, there is no up or down, it's only as you define it.

Of course that's because the idea is that mental illness is the patient's responsibility, by default of waiving any legal responsibility through "de-medicalization". Just like that, the absence of any obligation becomes the patient's sole responsibility. What a happy coincidence that it's only ever talked about as a cost-saving measure. Happy for the bank accounts of some people anyway.


It's weird and circular I agree. And a lot of mental illness is an injury caused by someone else so the 'responsibility' bit doesn't add up either. If someone's hand is burning then you ask their perpetrator to take the iron off it. That's real scientific psychology as much as any other science. How this warped 'thing' entered and didn't get hounded out I don't know because 'situation' and 'sorting it' is the mainstay of the first job even for psychology. So how instead of 'functional support' and 'medical support' in the presence of an injury someone has justified 'thinking wrong' I do not know.

This CBT suggests pretending that the fix is tht someone thinks differently so it damages them less, or needs mental training to remove said iron what either themselves or by persuading the individual, but it's down to them it stays? Or does it assume the iron itself was imaginary, and the iron-shaped burn is 'the mind'- no wonder they use storytelling and not logic to bore people into believing they are saying something of sense, there is some seriously dodgy metaphysics going on here.
 
An active blog focused on claims relating to CBT and IAPT, by Dr Mike Scott.
http://www.cbtwatch.com

It describes itself as 'An Independent Mental Health Watchdog and Discussion Forum'


It's not anti-CBT, but is anti-IAPT. There's a lot of well referenced material there that is likely to be of interest to those concerned about IAPT.


From the 24 Feb 2021 blog 'IAPT: Suicidal and give online CBT'



From the 17 Feb 2021 blog 'IAPT fails to rebut charge of a tip of the iceberg rate of recovery'


Yes I often have to point out to people that 'BPS' (biopsycho) is actually anti-psychology. So we have all sorts of double-think where they accuse those who question them of anti-mental health.

Goodness knows why those who do CBT that is properly developed around a condition that was mapped, and the 'cause' of said condition that is linked to that CBT type actually helping, allowed under their brandname this warped rip off. They only have themselves to blame for not speaking out and for letting it ruin their reputation, not anyone who rightfully criticises cfs or mus 'cbt'.

What's the point it's like teachers letting someone introduce 'education lessons' where it doesn't matter what your issue is, or whether the cause is situational or physical just chuck all kids of all ages into a generic thing that 'teaches stuff'. They are still 40mins or whatever length long and use lesson plans so they must be the same thing.
 
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"Kellett et al (2021) claim that it would be too expensive to have a high quality, ‘gold standard’ effectiveness study with independent blind assessors using a standardised semi-structured diagnostic interview. But set against the £4billion already spent on the service over the last decade the cost would be trivial."

Shocking numbers isn't it. And nearly all of the presentations I see to CCGs say it is cost neutral and have all sorts of savings calcs about 'care and benefits' reductions. And saying it will increase the workforce. To quote what I found in the PACE minutes about the DWP only funding research that would use 'return to work' as an outcome (although I'd suggest they look at that over a longer time period and check the hours etc given many get 'nudged' back) you'd think they'd want to know that was correct rather than take them marking their own homework before making decisions on it.

According to the Kings Fund £1bn = the current annual budget for the Nottingham Hospital Trust: https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs

It is like having 4 hospital trusts saying they are too busy to check whether anything they did worked independently then?

They really are taking these claim 'cost savings' literally aren't they. Wonder what having a few consultant-led biomedical ME clinics would cost and how much they claim is allocated on the basis of ME/CFS? Because they sure seem to be using that illness as a claim for their moving into LTCs. And have a few testimonials in their presentations.
 
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