IAPT under the microscope, 2018, Marks

Open access at http://journals.sagepub.com/doi/full/10.1177/1359105318781872

 

My emphasis and underlining.

To fully recover from, for example, diabetes, one would need to become "not diabetic" and all damage done to body tissues would need to be reversed. To fully recover from COPD one would need a new set of lungs. COPD is a progressive disease that slowly destroys the lungs and the damage has never been reversed as far as I know. Cardiovascular disease - as a minimum arteries would need to become unclogged.

No amount of talking therapy is going to achieve the things I've suggested. It simply cannot happen. So, what weird definition of "full recovery" are people invested in IAPT actually using?

 

Probably the type where either

you don' t go back because it does nothing for you and the assumption is that you have "recovered".

Your perception of symptoms has changed - particularly beloved of pain management- to enable you to fill out a questionnaire and magically be " recovered" ....

 

The only patients who could possibly fully 'recover' from this approach are those whose underlying problem is actually entirely psycho-behavioural.

 

I think the recovery claims are for depression and/or anxiety only.

 

So what benefits are there supposed to be for the people with diabetes, COPD, cardiovascular disease etc who are pushed into IAPT therapy?

 

Tge premise is that having a long term chronic health condition induces depression and anxiety .....

 

And treating the depression and anxiety will get sufferers back to work and off benefits?

 

From The Improving Access to Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms Full implementation guidance — section 2.2, pp. 13-15:

[PDF] https://www.rcpsych.ac.uk/pdf/IAPT-LTC _Full_Implementation_Guidance.pdf

 

"depression is associated with increased rehospitalisation rates in people with cardiovascular disease and COPD, compared with the general population"

But surely that's because 'the general population' don't have COPD and cardiovascular disease or am I reading this incorrectly?

"people with MUS who were not offered psychological therapies as part of their care were found to have a higher number of primary care consultations"

again, that's obvious to me. They want to know WTF is wrong with them! and if the GP keeps fobbing them off.............then they are sent along to a therapist who will at least listen to them for a while.
But I bet that once they've finished the psychological therapy they wouldn't bother going back to the GP as they know they won't do anything..........so bingo they're cured.........until they end up in A and E with something serious.

 

Or maybe, just maybe, severe COPD can leave you feeling depressed.

Or maybe having severe COPD just makes you tick more items on a depression scale, so you're more likely to "look" depressed? I wonder how many items examine fatigue, concentration, sleep, all of which may be compromised in COPD? I bet its never occurred to anyone to have a look at the scales they use, and check they are valid for use with the chronically ill.

 

The depression symptom measure is, I think, always the PHQ-9 irrespective of condition. Anxiety/MUS symptom measure depends on the so-called problem descriptor, but is GAD-7 for several problem descriptors. In the case of MUS referrals, it depends on the condition.

In CFS it would be PHQ-9 for depression (despite no requirement for depression to refer) and the Chalder Fatigue Scale for MUS, with GAD-7 if the CFQ measure is missing.

The PHQ-9 (for instance) will certainly register answers that are given as a result of loss of function, wellness, and quality of life as indicative of depression.

Exactly right.

 

"The Cost of IAPT Is At Least Five Times Greater Than Claimed

8th August 2018

Published in BMJ

full letter here:
http://www.cbtwatch.com/category/iapt/

 

It is interesting to see how most of the people involved in this debate, including Scott, shy away from the elephant in the room - that the evidence for psychotherapy is not good enough. Scott criticises PACE on selection criteria but fails to point out that the study tells us nothing about effectiveness of CBT even in the patients treated.

What I seem to see here is as much as anything jostling for a piece of the cake amongst the psychology fraternity.

 

Here's the BMJ Rapid Response: https://www.bmj.com/content/344/bmj.e4250/rapid-responses

It was attached to the 2012 BMJ article.

I don't trust the official IAPT recovery figures, and they seem likely to really exaggerate the true 'recovery' rate, but I'm not sure about Scott's 10% figure either.

He only looked at 90 cases, and we don't know how representative these cases were of those who attended IAPT so I don't have much confidence that the 10% figure will hold up.

 

Didn't know where to put this; comments on CBT Watch:

".....we do need good quality talking therapies but we have not got them, rather we have a 10% recovery rate for those undergoing treatment with IAPT http://journals.sagepub.com/doi/pdf/10.1177/1359105318755264.
I very much doubt that IAPT or anyone has an evidence based psychological treatment for a person with bipolar disorder and it would be disingenuous to pretend we have.

Nevertheless IAPT has trespassed into providing treatment for medically unexplained symptoms, which is an unfortunate precedent for claiming more than we can deliver."

"Will IAPT reform itself before it is too late? There is a glimmer of hope, in that I did not meet with open hostility recently when I suggested that it needs reconfiguring to ensure reliable assessment.

But the economic argument for IAPT will be in tatters after a new paper is likely published in the coming months, which will show what the National Audit Office has signally failed to make public – a matter for the House of Commons Public Accounts Committee."

http://www.cbtwatch.com/