Last updated on 12th August 2010
It's the third and last day of this annual BABCP conference (although I'm posting this a day after writing it). I wrote yesterday about a symposium I went to on the second day. Today I was more settled - I got out for a pre-breakfast run and then had a chance to meditate. There's nothing that really grabs my attention in the first set of symposia this morning, so I'm taking the opportunity to review how the conference has been so far and what my plans are for the rest of the day.
Of the three plenary presentations at 11.30am I intend to go to David Clark's on "IAPT: achievements, lessons and the future". I've heard him talk, read most of his research articles, and been to the occasional workshop with him over the years. One could make a reasonable argument for David being the most "influential" cognitive behavioural therapist in the UK. I like how his mind works and I have great respect for his energy and commitment. He seems pretty cool, in various senses of that word. Then this afternoon I hope to get to a panel discussion on "Metaphors and stories in CBT" - probably not very evidence-based, but clinically fascinating.
... and now it's the afternoon. David Clark's talk on IAPT was great. Inspiring and humbling. We're nearly two years into the six year, £300 million Improving Access to Psychological Therapies (IAPT) initiative. Apparently 115 of the 154 English NHS Primary Care Trusts now have access to IAPT services and an additional 2,500 therapists (both "high" and "low" intensity) have been appointed and started training. David gave an overview of IAPT's origins, development and interim results. They look encouraging. It's tremendous that many more people are getting access to evidence-based interventions for their psychological difficulties. As a therapist - not an administrator or politician - a few additional titbits I noted were that, although CBT is the only therapy that appears currently recommended by NICE for the treatment of anxiety disorders, with depression the position is considerably broader. I understood that CBT, Behavioural Activation, Interpersonal Psychotherapy, and Behavioural Couples Counselling are all recommended, and would-be clients can also opt for Counselling and short-term Psychodynamic Psychotherapy. These are similar recommendations to those provided by the recent Scottish SIGN guideline on non-pharmaceutical treatments for depression. A second clinical titbit was a description of the (still in-press with the Journal of Consulting and Clinical Psychology) Hollon meta-analysis of depression psychotherapies showing a similar picture to the one found for depression pharmacotherapies (obviously one may well prescribe antidepressants for many other disorders than just depression - for example, for anxiety). For milder depressions it seems that currently recommended psychotherapies are only slightly more helpful than placebo interventions. David however pointed out that - at least in research on therapies for pain - not all placebos are equally effective, e.g. placebo injections may be more effective than placebo capsules which may be more effective than placebo pills. He wondered what this difference between different forms of placebo, or non-specific aspects of treatment, might mean for psychotherapies. I would argue that it shows that factors we're not currently assessing are of importance, and that it may well be helpful to identify and then maximise them. For example, what "non-specific" part is played by the therapist and the therapeutic alliance? Apparently it isn't until one gets to more severe levels of depression that it seems increasingly important to get well-validated interventions. I look forward to reading this paper in the Journal of Consulting and Clinical Psychology when it comes out. With antidepressants, this distinction from placebo only begins to emerge clearly at really quite severe levels of depression. The third titbit was that the current general anxiety measure recommended in the IAPT programme - the GAD-7 - is really not targeted enough to be helpful for most specific anxiety disorders. It's important to use a recommended specific measure to be able to assess and monitor change - see this website's page on "IAPT recommended measures" for downloadable copies of these questionnaires.
I said David Clark's talk was inspiring and humbling. He has brilliantly helped to develop better treatments for panic disorder, social anxiety and posttraumatic stress disorder. Currently - with social anxiety disorder - he and his colleagues are putting together an internet version of the treatment that they hope to make freely available worldwide. This is serious stuff. Here - with IAPT - we see a contribution on a national level to treating psychological disorders better. The results of this initiative will be attended to by many other countries. This again is serious stuff. How to be inspired by this? The Hasidic rabbi Susya, nearing his death, is reported to have said "When I get to heaven, they will not ask ‘Why were you not Moses?'. They will ask ‘Why were you not Susya? Why did you not become all you could become?'" George Vaillant, in his fine book "Aging well", talks about the challenges we may face at different life stages. See too Erik Erikson's work on the stages of psychosocial development and the importance of "making a difference". This blog is one of my own responses to the challenge of generativity and "making a difference". Next week is the Memorial Celebration for my dear mother. After that there will be a little more time available for me - a chance to re-engage with our Scottish Charity Depression Alliance, to teach a bit more, to look again at the ogre of climate change and how maybe I can do some very small thing here too. I'm not going to be "Moses", but great to be inspired and to try to be "Susya".
See tomorrow's blog post for thoughts about the afternoon session on "Metaphors and stories in CBT".