"It's some time since I commented on IAPT - Improving Access to Psychological Therapies, now often called Wellbeing Services (eg. see previous post). I've just looked at a recent lecture from David Clark (see video). He's still making claims about outcomes based on lack of comparative data. How do we know that so-called recoveries in the IAPT programme are not due to the placebo effect or spontaneous improvement?
For example, in the lecture Clark makes much of the changes in Buckinghamshire Healthy Minds following a review of notes of the unrecovered patients to identify themes and recurrent patterns in the data (see powerpoint presentation). National figures are that 46% of people are said to recover and a further 15% improve. These are average figures and there is considerable variability by Clinical Commissioning Groups (CCGs). Buckinghamshire was below 50% and by telling staff to increase recovery rates to 65%, lo and behold they did! Isn't this just a Hawthorne effect?
There's a lot of money invested in IAPT so I'm sure Clark doesn't want to think about whether IAPT therapists are mere placebologists. There will always be a problem with assessing the effectiveness of psychotherapy because of the issue of the adequacy of control groups (eg. see my BMJ letter). Psychotherapy trials cannot be conducted double-blind because subjects always know whether they have received the therapy under investigation or a control intervention"
and my comment:
"Thanks for blog post. I am keen to see psychological therapies offered on an equal basis to psychiatric drugs for people experiencing mental distress, altered mind states, psychoses and in emotional crises. Therefore I want the research on talking therapies to be thorough and relevant, to focus on people's voices, their stories about recovery.
You say that there will "always be a problem assessing the effectiveness of psychotherapy". I can't see the BMJ letter because of paywall (got a copy from a colleague, see below). However surely the testimony of the people receiving psychotherapy and other talking therapies has to be of value? How they feel about the service, whether they have increased confidence and wellbeing.
I think that psychiatric drugs may appear effective in the short term by reducing symptoms but in the longer term are counter-productive. I speak from personal experience, my own and many family members who have had to live with the side effects of the drugs. Many of which cause anxiety and other disabling conditions. Antipsychotics depressed me. I had to taper and get off them to have a life. And did so under my own steam. Although in 2012 my youngest son was supported in the taper by a psychiatrist. But we got NO other support from services. We were left to get on with it. Solo. No CBT which we asked for. So I had to support my son cognitively, helping him to work through negative thinking. He did the work, I was a listener.
My son, who has a bipolar disorder diagnosis, is very gradually recovering from the psychiatric abuse of the locked seclusion room and other indignities. The flashbacks in the first year after his discharge from hospital were terrible. We did not expect the sub-human treatment, it was a shock. And we are still living with it, coming to terms with it.
Therefore I welcome your blog post and challenges about IAPT outcomes. For we need valid, proven alternatives to drug "therapies" for mental health treatment. And I believe we need research partnerships and co-collaborations between people who provide talking therapies and people who have survived psychoses, psychiatric treatment and mental illness prognoses. A level playing field where life experience is of equal value to academic qualifications. Although some of us who have survived psychiatry are academically qualified in other areas (community education, FE lecturing)."
Dr Duncan Double's BMJ Letter, mentioned in blog post: