Michael J Scott

  • Over a decade ago, I wrote a trilogy of books under the ‘Simply Effective CBT’ umbrella. Starting with Simply Effective CBT [ Routledge 2009]. Then Simply Effective Group CBT Routledge 2012] and finally Suitably Effective CBT Supervision [Routledge 2013]. My idea was to aid in the dissemination of CBT by drawing on my real-world experience of delivering CBT. Despite the popularity of the books, the gales that have prevailed since publication have turned the umbrella inside out. Attempts to right the umbrella [ Towards a Mental Health System that Works , Routledge 2017] have failed and most recently in 2025, my abandonment of writing CBT Treatment Engagement for Routledge.

    The result has been disengagement from CBT, in ‘Thanks, But No Thanks’ published last year [Scott (2025)] I wrote with regards to NH S Talking Therapies:

    Almost half (45%) do not complete treatment, and for completers, the results are no better than for placebo. The diagnostic status of almost a third (29.1%) who attend just one session is unknown. The numbers of people who attend one assessment/ treatment session is approximately half of those who attend two or more treatment sessions, but the ratio varies by disorder.

    This has been met with radical apathy in the UK, but was met warmly by the Spanish Society of Clinical Psychology at their Annual meeting in Girona, Spain, May 2026 ‘All Talk and No Action’. 

    Last Saturday, over lunch I was trying to explain to a childhood school friend , a businessman, why it is that the UK Government has spent £2billion a year for almost 20 years, on NHS Talking Therapies/IAPT, without any independent audit. He looked at me with incredulity, a dip in the River Mersey seemed inviting.

    Dr Mike Scott




  • You wouldn’t think so with a likely 1000+ delegates, to the British Association of Cognitive and Behavioural Psychotherapies (BABCP) Annual get-together in 2 weeks time. But the key distinguishing feature of CBT, is the setting and review of homework. My inspection of 100’s of records [Scott (2026)] shows that it is conspicuously absent. ‘Alleged CBT’ abounds, but there is no documentary evidence that it takes place in routine practice. Whither accountability?

    CBT appears to mean whatever a therapist wants it to mean. So much for evidence-based CBT! There is a transdiagnostic version of CBT called the Unified Protocol, but there have been no sightings of homework associated with this, in the 100s of GP records that I have reviewed.

    It appears that we are invited to believe by the BABCP power-holders and Courses that CBT actually happens. Is CBT a Dodo?

    Dr Mike Scott

  • Using AI for psychological therapy appears a ‘no-brainer’, no need to disclose anything, readily accessible, little or no cost. Given that NHS Talking Therapies has failed to demonstrate superiority over any active control condition, AI is an attractive option. AI’s treatment integrity, i.e faithfullness to a CBT protocol is no less evident than the philandering with protocols in NHS Talking Therapies. It is likely that AI will perform no better in terms of outcome than the tip-of-the iceberg recovery rate in NHS Talking Therapies [Scott (2018)].

    An editorial in the British Journal Of Psychiatry by Shafran et al (2026) suggests that NHS Talking Therapies data could be usefully mined by AI. But fails to point out that the data has first of all to be ‘meaningful’. A test score [PHQ-9 or GAD-7] by itself has no meaning, it is just a number. AI is not Alladin’s magic lamp that can be ‘rubbed’ to transform numbers into meaning. The numbers per se are not credible units of analysis, the input into AI has to be something that the ordinary person would recognise, e.g becoming able to see at a distance following treatment. Numbers demand an explanation, NHS Talking Therapies data is ‘vapour-ware’.

    Dr Mike Scott

  • Presentation at Annual meeting of Spanish Society of Clinical Psychology, May 31st 2026 https://youtu.be/cLIMXz4eW0A in Panel Symposium on Primary Care

    https://youtu.be/cLIMXz4eW0A

    Dr Mike Scott

  • NHS England is due to be abolished and NHS Talking Therapies integrated into the Department of Health. But without any guiding vision, personalities and saving jobs is likely to be the name of the game.

    The history to date does not augur well:

    • As originally envisioned in 2008, at the setting up of the Improving Access to Psychological Therapies (IAPT) Service [the predecessor of NHS Talking Therapies] the aim [Mission] was to provide evidence-based protocols for specific disorders.
    • In 2023 IAPT became NHS Talking Therapies for depression and the anxiety disorders. Psychological therapy became talking therapy and the scope limited to depression and the anxiety disorders. [Vision obscured}
    • This has given rise to the question ‘what are the boundaries of talking therapy’, ‘is anything not talking therapy.?’ By 2026 it has become clear that the Service addresses ‘distress’ as opposed to specific psychological problems. Government is spending £2 billion a year on adult and child mental health but there is no mandate for ‘distress’ being the focus. The key Value is that those with psychological disorder are enabled to flourish, as to are the ‘enablers’. The needs of the distressed are, arguably, already catered for by the Citizen’s Advice Bureaux (CABx) addressing financial, housing needs etc. It is a waste of resources to have therapists become de facto CABX workers.

    The plot has been well and truly lost, despite over a million recipients of the Service a year. The time for a new vision is well overdue.

    Dr Mike Scott

  • Did we really intend to create a £2billion a year service to treat ‘distress’? The gateway to its’ services have been by prospective users completing the PHQ-9 and GAD-7, measures respectively of the severity of depression and generalised anxiety disorders. With three quarters of people identified as ‘cases’ of either using established cut-offs, Vos et al (2026). These authors recommend instead the use of the CORE-10 a measure of general distress, which produces a caseness level of 87.3%, ensuring that all are casualties and presumably in need of treatment. The corresponding proportions for caseness for the PHQ-9 and GAD-7 were respectively 71.0% and 74.8%. It is doubtful that the measures are meaningfully distinguishing amongst each other.

    NHS Talking Therapies boasts NICE compliance. But the latter make no recommendations on ‘distress’ how then can the National Service be compliant? Let us be honest the Service does whatever its clinician’s fancy. It is scarcely credible that this randomness can usher in real-world changes in the lives of clients.

    Levis et al (2019) found half the depression cases identified using the PHQ-9 were actually misdiagnosed. What a waste of treatment efforts. If you wanted to set up a wasteful treatment Service NHS Talking Therapies fits the bill perfectly. But no hint of this in the missives of the annual gathering of the British Association of Behavioural and Cognitive Psychotherapists (BABCP) in mid-July. However this Saturday May 31st, in a presentation titled ‘All Talk and No Action’ to be given at the annual meeting of the Spanish Society for Clinical Psychology I will give voice to such concerns.

    Dr Mike Scott

  • The Service solicits questionnaire results from each client at every therapy session. With over a million clients a year and an average of seven treatment sessions per client for completers, that’s a massive amount of data. But to paraphrase Coleridge’s Ancient Mariner, ‘NHS Talking Therapies data everywhere and not a drop to drink’. 

    Talking Therapies proclaims that the data reveal a 50% recovery rate, comparable to that in randomised controlled trials of CBT for depression and anxiety disorders. The UK Government’s Office for National Statistics (ONS 2024) has stated that there are not only health benefits but that the NHS Talking Therapies treatment has led to an increase in income and reduced unemployment. However, the government’s National Audit Office (NAO) has been strangely silent on whether the Service is value for money.

    But it is not possible to discern the operation of any plan in NHS Talking Therapies ministrations. There is no documentary evidence of the setting and review of homework at each therapy session. Given that CBT is distinguished from other psychological treatments by its psycho-educational nature, there is considerable doubt that CBT has in fact been administered. The National Institute for Health and Clinical Excellence (NICE) guidelines state that evidence -based-treatment should be diagnosis specific, but the service clinicians are not trained to diagnose. The meaning of the data collected is therefore opaque. Though the data collected has grown exponentially since the inception of the Service in 2008, it is no more valid than it was at the beginning. But the ONS’s conclusions assume that the NHS Talking Therapies proclaimed narrative is true. Without this solid foundation their assertion of positive economic effects crumbles. 

    What NHS Talking Therapies clinicians actually do is to ‘tinker’, CBT sounding phrases abound, but it is ‘All Talk and No Action’, with no evidence of the dovetailing of treatment targets with matching treatment strategies. There has been no independent assessment of treatment integrity. The Service asserts that its’ clinician’s interventions are guided by their formulations, but there is no evidence of the reliability of these plans/formulations. There is no evidence of intelligent design behind the Service. Unsurprisingly the response of a third clients is ‘thanks, but no thanks’ [ Scott (2025)], attending only one assessment/treatment session. For every ‘decliner’ two people attend two or more treatment sessions. 

    Tellingly the diagnostic status of NHS Talking Therapies clients has never been assessed independently by a publicly funded body using a standardised diagnostic interview. The duration of ‘recovery’ has never been assessed – psychometric tests only give a snapshot picture of the client at a particular point in time. Clients wish for real-world recovery not to be ‘tinkered’ with. My own study [Scott (2018)n] of NHS Talking Therapy clients showed only a tip of the iceberg recovery rate.

    Dr Mike Scott

  • There has been an exponential increase in the number of treatment manuals since the 1970’s. But only 13% are cited in treatment guidelines such as NICE. Further there is no evidence that these tomes have made a difference to routine practice.

    NHS Talking Therapies swears allegiance to NICE Guidelines, but documentary evidence of compliance with the Guidelines has been conspicuously, totally absent in the 200+ cases I have reviewed. This is the subject matter of my Keynote address to the Spanish Society of Clinical Psychology on May 30th 2026, ‘All Talk and No Action’.

    Initially the treatment manuals were all diagnosis specific. But in recent decades they have been increasingly transdiagnostic. The new conventional wisdom has been that manuals are the ‘problem’, perpetuating the idea of diagnosis. But this position is no longer tenable. Flexibility without fidelity has become the new norm, with idiosyncratic formulation ruling. Making a formulation ‘stick’ depends on a person’s position in the hierarchy, with academic clinicians running CBT courses at the top, marketing themselves with ever more manuals.There has been no independent audit of the legacy of these manuals at the coal-face.

    Dr Mike Scott

  • ‘I’m just a number”, a common response of individuals treated badly by their employer. But the ‘bread and butter’ of AI and NHS Talking Therapies is data points. Just as an employee might protest that they are more than a unit of production, so to clients may protest about a reduction of their experiences to a score on a questionnaire they completed.

    NHS Talking Therapies boasts more than a million clients a year, with questionnaires completed on each after every session. There is no doubt that they have accrued voluminous data. But the data does not speak for itself. A score on a questionnaire has no intrinsic meaning. Multiplying the number of questionnaires completed provides no added evidence of anything.

    It is possible to treat the results of trained clinicians as a ‘gold standard’ against which to assess the performance of Chatbots. But the vetting procedures for the ‘gold standard’ needs to be robust. There has been no independent evidence that what trained clinicians generally do makes a ‘real-world’ difference. A consensus judgement about ‘good practice’ is not evidence. As in a Court of law, evidence must be based on multiple independent assessments and a variety of information sources. In lieu of a reliable database, appeal is made to the results of randomised controlled for depression and the anxiety disorders. But this is to ‘impersonate ‘ the rcts, the latter had independent assessments of the diagnostic status of clients before and after treatment and follow-up. Comparability of effectiveness with the rcts is a ‘con’.

    It is quite possible that Chatbots do just as well or badly with sufferers from anxiety/depression as NHS Talking Therapies. But this is because of the employment of metrics of convenience, rather than validity. The irony is that this could be seen as a cost-saving way of eliminating at least low-intensity therapy. The Service has backed itself into a corner, hoisted by its’ own petard.

    Dr Mike Scott

  • NHS England has continued to use a metric of recovery for those undergoing its’ Talking Therapy service that is known to be invalid. This costs the British taxpayer about £2 billion a year. It boasts a 50% recovery rate. The primary metric used is the PHQ-9, an alleged measure of the severity of depression, with a cut-off of 10 or more used to designate a case of depression.

    Recently Hlynsson et al published a paper titled ‘Why are we still using the PHQ-9?‘ they observed fundamental problems:

    • a confusion about whether the instrument is measuring the frequency of a symptom or how bothersome it is
    • because of this confusion clients can respond differently on separate occasions and this does not necessarily reflect a change in symptomatology
    • false positive rates often exceed 50%
    • The PHQ-9 uses a two-week time frame but it is administered at every session in NHS Talking Therapies, which are often weekly. The instrument has not been validated for use in this way
    • ‘there is a need for greater transparency and independent evaluation of assessment t. ools’

    The PHQ-9 is at best a measure of the severity of depression, it is nonsense to use it as a yardstick for every disorder that presents to NHS Talking Therapies. This echoes the findings of Panayotiou et al 2026 ‘this study identified widespread misinterpretation of the PHQ instructions across community and clinical samples, raising doubts about its validity for both research and clinical decision-making’.

    The PHQ-9 had its’ origins in Pfizer’s marketing of a drug, 20 years on it’s the mainstay of NHS England’s marketing.

    A client could make a claim that NHS Talking Therapies has not discharged their duty of care to them by relying on a dubious diagnostic instrument and navigating treatment accordingly. Their plea in mitigation that the Service doesn’t make diagnoses, rings hollow.

    Dr Mike Scott