The IAPT Pathway for People with Long-term Physical Health Conditions and MUS. Full implementation guidance.

IAPT’s Training Of Therapist’s On Working With Long Term Physical Conditions Muddies The Waters on Efficacy

20th March 2019

the evidence base that CBT works with the psychological sequelae of physical conditions is of a wholly different order to that for depression and anxiety disorders (the original remit of IAPT).
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To my knowledge, there are no studies in the LTC area that a) compare the CBT treatment with an active credible attention control group and b) involve independent assessment by a person blind to treatment. Rather outcome assessments are entirely by self report measures such as the PHQ9 and GAD7 of dubious relevance to the destabilisation that can arise from having an LTC.
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http://www.cbtwatch.com/

eta: see also earlier post on blog
All IAPT Generated Studies Breach Evaluation Guidelines
"An international team of Experts led by Jenni Guidi et al (2018) (see dropbox link) has recommended that for all trials of psychological interventions ‘Assessments should be performed blind before and after treatment and at long-term follow up’. But IAPT have been it seems “totally blind” to this need for independent standardised assessment."
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This makes the evidence base for CBT more questionable than NICE would suggest.
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I've just had a look at the CBT watch website. It consists of a series of short blog posts by a Dr Mike Scott, and a failed attempt to get a forum going for CBT therapists to share ideas and concerns that has 3 empty threads started by Scott in 2017.
So basically it's a personal blog.
There is no information I can see about who Dr Mike Scott is, but he is clearly concerned about IAPT.
 
Comment under the previous blog:
MichaelB
21st March 2019 at 11:02 am
There is a study on CBT and ME, PACE, oh dear https://www.roydswithyking.com/pace-trial-scandal-me-cfs/
Definitely reason to be concerned.
Am I missing something? with NICE having to rethink the new Depression guidelines, does this not mean there is no evidence base at present? Shouldn’t IAPT suspend its “treatment”.
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REPLY:
Interesting Michael, in the PACE trial there was no blind assessor, looking at an objective measure of outcome such as how far people can walk, the emphasis in publication was on subjective measures with no attempt to compensate for this by at least ensuring blindness. The trial lacks credibility

Mike
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Sly Saint said:
Comment under the previous blog:
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This legal firm seem to have been tracking the PACE trial issues for some time now, and this shows they are keeping themselves up to date. I think their continuing interest maybe means they smell the potential for a lot of business that might come their way.

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The Improving Access to
Psychological Therapies (IAPT)
Pathway for People with
Long-term Physical Health
Conditions and Medically
Unexplained Symptoms

from March 2018
https://www.england.nhs.uk/wp-conte...al-therapies-long-term-conditions-pathway.pdf

"70% of people with MUS such as IBS or CFS will also experience co-morbid depression or anxiety disorders"

do we know where this stat came from?

also, isn't most of the 'research evidence' that the recommendations are based on mostly using CBT to treat the actual 'condition' (ie cfs) as opposed to treating co-morbid depression or anxiety?

If the idea of IAPT is to combine the medical and mental healthcare, where/what is the medical care for pw ME or CFS?
 
Sly Saint said:
also, isn't most of the 'research evidence' that the recommendations are based on mostly using CBT to treat the actual 'condition' (ie cfs) as opposed to treating co-morbid depression or anxiety?
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Looking at this document two things send out for me.

Firstly it is written like an advertising brochure rather than an evidence-based guidance document.

Secondly, it is completely opaque is to what type of CBT is being suggested for 'MUS' and for what purpose. The most ambiguous sentence is:

An expert advisory group was convened by NHS England to review existing NICE guidance for the use of psychological therapies for the treatment of depression and anxiety disorders in the context of LTCs and the treatment of MUS (see the box on the right).

This makes it sound as if this is treatment for MUS, not for co-morbid anxiety and depression. But the box on the right does not tell us.
 
Sly Saint said:
do we know where this stat came from?
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There are lies, damned lies and statistics.

This one is a beauty: this patient population is systematically and incompetently misdiagnosed with mental health issues, therefore they statistically suffer from mental health issues. Ethically, this is like police officers mass-planting drugs on suspects and showing those in statistics to justify why they were justified in making those arrests.

It's a self-reinforcing ouroboros of bullshit.
 
Keela Too said:
@dave30th might also find this interesting. I think the wording on the page is ambiguous however.
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I just randomly saw this last night so wanted to post a link to it without making any comment. However, on revisiting the site, it is notable that the list doesn't include 'Long term conditions', or the relevant links to the NICE guidance on, for example, diabetes, MS or Parkinsons.
 
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I notice one of the responses to the blog linked above highlights this training day on LTC's and MUS by the Royal College of Psychiatry:
Working with Long Term Physical Illness & Medically Unexplained Symptoms

This description of it gives me the horrors:

Overview
Patients with long term & medically unexplained physical symptoms present in a range of settings. Many clinical presentations are poorly explained by existing anxiety-based treatment models. This workshop will provide clinicians with specific assessment and management skills based upon the so-called five areas assessment CBT model - and focus upon a range of interventions to help the patient use experiments and structured problem solving plans to improve how they feel.

After you have attended this course you should be able to:

• Describe the range of illness responses and understand these using a cognitive behavioural framework

• Help make sense of the patients current presentation – including how to assess complex presentations such as chronic fatigue and pain

• Identify factors that are worsening how the person feels and choose realistic targets for change

• Use concepts such as pie charts to help patients reattribute the causes of their symptoms

• Describe in detail a plan to increase activity levels in order to overcome avoidance and reduced activity
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