Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified, 2020, Geraghty and Scott

Open access, https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-020-0380-2

 

Added line breaks for readability purposes.

 

Very good paper with some interesting information:

It appears that the problem is maybe not with psychiatry but with some zealots that have strong but unproven ideas on unxplained symptoms.

Essentially, it is possible to fantasize about how patients make themselves worse with their thoughts and behaviours and they just accepted that as truth even when there's no evidence this is actually occurring.

Deary et al. also state:

An admission that testing of a generic CBT MUS model is impossible.

As the PACE trial shows, this line of research failed to produce any credible results.

In other words, psychotherapists have no medical training and many illnesses are not easy to diagnose even by those with the training.

Not disclosing the treatment rationale to patients would seem to exclude genuine collaboration. It would therefore not be CBT as intended by its inventor.

 

And would not be informed consent? So, especially if harm occurred, then they may well be on dodgy legal grounds, although no doubt their argument would be they were working on the basis of the best evidence that they had available to them.

 

But they had no evidence for the correctness of the model, and no credible evidence for efficacy of the treatment either (see PACE trial debate).

What is happening here is that a story was made up to facilitate selling CBT. It's a fraud.

It's no different from making up a story of how eating yak butter cures unexplained symptoms, and then selling it to the healthcare system. Well, the difference is different levels of skepticism by society. A healthy amount for claims involving yak butter and similar, but a childish credulousness when it comes to claims of psychogenic illness and psychotherapy.

 

I don't disagree with anything you write but the people delivering IAPT treatment for "MUS" would be able to use the "best evidence available" defence. The ones who made up the "evidence" will, most likely, never have to defend themselves.

 

The biggest problem with MUS from my point of view is that it assumes doctors are perfect diagnosticians who never make mistakes. The patient is assumed to be lying or attention-seeking or drug-seeking or deluded or to have various other problems. The doctor can't be wrong, can they? And let's face it, a mistaken diagnosis of MUS never causes the doctor any suffering. It is always the patient who suffers. It is this which makes MUS the most sadistic treatment idea that anyone ever came up with and doctors just governmentally approved torturers. And the fact that less and less treatment of any medical condition is available on the NHS is just going to make life suck worse than it already does for vast numbers of people. I'm convinced this whole thing isn't just institutional sadism but is a deliberate population reduction policy.

Rant over!

 

I think they may well be stepping on the edge of thin ice here. One could argue that PACE demonstrated that CBT (directive for ME) doesn't really work. It is now on open record (thanks to forums like this one) that patients haven't found it helpful, have sometimes found it harmful and had feedback deliberately ignored.

Sooner or later they are going to go fall through that thin ice. While they are dragging their heels, more evidence and arguments are being produced and publicly discussed. They no longer have the luxury of deniability. The longer this farce goes on for the heavier the penalties will be.

 

....however we have invented hundreds of labels that ensure this happens anyway.

 

At this point things being what they are in the world, it may be possible to argue for a precedent on the grounds that justifying a defence on best evidence given the facts would encourage future abuses of the same kind. Or so I'm going to think until reality kicks in.

 

It would depend on expert witnesses if it got to that stage. The argument was that person x should have known based on evidence y that someone could be harmed.

The expert witness for person x would argue that the information wasn't reliable, well distributed or accepted. They would use things like the NICE guidelines and NHS websites to justify it as being the current accepted practise.

 

Thought all that expert witness opinion stuff went out with - Montgomery v Lanarkshire Health Board.

 

Important point:

The rationale behind the programme is self-defeating, proportionally to its success. Being unsuccessful is actually the only reason it does not crumble under its own weight, with most patients referred being filtered out. If the programme were successful it would be unable to meet its own demand, especially given the peeks we have seen behind the scenes, of massive turnovers and staff that actually meets the selection criteria for their own services.

In the end, those patients referred to IAPT are not helped by their GP and even less so by the programme. So the exact same outcome, but are actually dropped twice. One says not my problem, the other also says not my problem. Billions later, you now have doubled all your problems, at great cost and with no benefits. Just BPS things.

 

Both sides can call on expert witnesses though. The longer this goes on the more evidence will be stacked against them.

I'm not saying we'd win a case today or even tomorrow, but the day will come.

 

Well, they will find a report, as part of the documentation of the next ME NICE guidelines, from this expert witness making it absolutely clear that the weight of evidence for CBT and GET is that they do not work. I won't mind having to justify that in a court of law under cross examination. I have got to rather enjoy being cross-examined in medical cases!

 

it would be great if you could slip in there that web-based CBT doesn't really do much for symptom improvement in IBS as well but now is being pushed to be offered to everyone who presents with IBS.

 

it is rather perverse that people in serious need of psychological counselling are being turned away in droves due to lack of funding but empire builders are draining funds for something that benefits no one but themselves . is there no individual accountability for the overpaid and obviously inept boards who sign off on this fraud.

 

cbt watch
IAPT’s Mistreatment Of Those With Medically Unexplained Symptoms (MUS)

http://www.cbtwatch.com/iapts-mistreatment-of-those-with-medically-unexplained-symptoms-mus/

 

For example, the APA Task Force blithely signed off on Somatic symptom disorder for DSM-5.