Saturday, March 26, 2016

How do we know that IAPT outcomes are not just expectancy effects?

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.


Anonymous said...

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. 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 who have survived psychiatry are academically qualified in other areas (community education, FE lecturing).

lynda sherlock said...

i agree Chrys their must be more research into different kind of therapies more personalised and centred care to help people recover. Their was no life skills taught or even given positive feedback or goal making to help a person to move forward and recover in a DBT therapy group. I personally think that 10 weeks for therapy which is standard is not enough especially with people recovering from long term trauma their should be away of talking about what has happened to you with skills along side to help you overcome and move forward. i do like the notion of the Finland study of open dialogue then are using in London i can wait to see how that progresses.
Their is to much going on about changing ones behaviour instead of acceptance of someones life history and with in that looking at the negative and positive behaviour of a person. Their needs to be emotional resilience training in school and mindfulness as well as tackling the stigma and discrimination head on. Two many young people are being let down by the system and not give choices straight away also as well know their not enough resources and not enough funding. Things need to change for young people in mental health we need to see a proactive stance and early intervention needs to happen now as part of the curriculum in schools. Often mental health starts for some in primary others in high school we need to see that young people are give life chances so they do not end up in a system for the rest of their lives but are able to manage in the community and access education employment ect but also the people who have been in the system for years they also need support to make positive life changes for themselves as well.
We need to see that no only medication is given in the short term but other positive things should be put into place like a hub where people can access services for debt counselling education/ basic english maths/ life skills cooking how to run a home, ect. Through my time and now ex service user if we had classes to empower people and help them make life choices for themselves holistically making small achievable goals. physically psychologically emotionally spiritually looking at the whole person and injunction with looking at physical and mental health care together joined up care.
Their is not enough done to help long term clients and i know early intervention is the way to go in our schooling system but also long term patients deserve to be able to make choices and be heard in their life. As medical staff intervene service users need to be listened to it is also important that a person has a voice because after all its their life and their choices to made what ever they can of their life . A person then can become to dependent on services instead of helping them look for integration into the communities they live in whether its through education, job, organisations who work in that community personally i think constantly just having organisation for people who suffer with mental health is to insular people need to be connected to the communities as a whole and then i think maybe the stigma might be less who knows but putting a load of people with one mental health problem together does not help i ve been their done that and it can be to negative we need to see more support in helping people empowering themselves to involve themselves in all parts of the community life and we then can see a much diverse community and more acceptance of people who are classed as different.
Personally i think we should stop telling people their is something wrong with them and start helping people with their symptoms much more holistically caring compassionate way of helping someone deal with their emotional distress, psychosis and emotional states. The negative labelling does not help people move forward it does not define someone and by labelling someone defective can cause more problems in the long run by stifling someones recovery and Independence their journey of their life and its not empowering at all.