Michael J Scott

  • The answer, according to the NICE Guidelines, is when it’s applied to those with depression NICE (2022)] and the anxiety disorders [NICE (2011)]. Thus, those with ADHD, autism, bipolar disorder, a personality disorder and severe mental illness would not be viewed as candidates for CBT, rather as being in need of support.  The Simply Effective CBT trilogy of books (1), published by Routledge, cover individual and group treatment of the most common disorders together with a framework for supervision. The series uses session transcripts and pocketbook appendices to bridge theory with actual clinical practice.

    CBT is effective when it is kept simple. NHS Talking Therapies is primarily tasked with the dissemination of CBT for depression and the anxiety disorders. But is CBT simple at the coal-face?

    Though CBT is psycho-educational, in routine practice there is scant evidence of the specification of homework assignments and their in-session review. According to the Service’s Manual practitioners are not trained to diagnose but the NICE treatment guidelines are diagnostic specific. N HS Talking Therapies claim to be NICE compliant rings hollow, it looks suspiciously like a lie.

    The limited scope of CBT is compromised if practitioners cannot distinguish one disorder from another or alternatively believe that there are no meaningful distinctions between disorders. In such circumstances doses of alleged CBT may be meted out to all and sundry. There is no empirical support for such an approach, but it is what happens in routine practise. More than a million people a year receive CBT in NHS Talking Therapies but there has been no check of treatment integrity i.e that the public actually receive CBT. Delivery of CBT is claimed to satisfy organisational demands and/or re-imbursement.

    Presiding Over Chaos

    The NHS Alliance (which represents health managers) has expressed alarm today that the identification and treatment of ADHD and autism is in ‘chaos’. They cite spiralling costs, in my own area Cheshire and Merseyside the cost of the treatment of Adult ADHD gas gone up from £11 million in 2023-2024 to a projected £51million this year [BBC News August 28th 2026]. But the  cost of NHS Talking Therapies, is £2billion a year for Adult and Child Services, and appears to have escaped scrutiny, without independent audit. 

    Lord Layard and Professor David Clarke were the prime movers in the development of   NHS Talking Therapies predecessor, the Improving Access To Psychological Therapies (IAPT). Lord Layard has just become the Patron of BABCP, ( The British Association for Behavioural and Cognitive Psychotherapies). BABCP claims to be the lead oganisation for CBT in the UK and is entering into discussions with Government on the development of mental heath services. It will inevitably support the interests of its’ 10,000+ members which include low and high intensity therapists. 

    The Government has promised to report soon on the state of the mental health services. It will likely want to be seen as supportive of mental health services and it is unlikely that there will be any critical appraisal anytime soon. Two points should be borne in mind a) the Channel 4 documentary broadcast earlier this month ‘The Great ADHD Myth’, suggested that there are usually simpler explanations for a person’s difficulties than ADHD such as a persistent depression or PTSD, which the dedicated ADHD service does not have the competence to rule out and b) the autism spectrum disorder notion is questionable, Uttah Frith developed the idea of ASD, but has recently suggested that it should only be applied to those with demonstrated intellectual development that was identified in childhood. Finally it should be asked after a decade of following the ADHD/Autism pathways where are the benefits other than  as a passport to acquiring services?

    Simply Effective Cognitive Behaviour Therapy: A Practitioner’s Guide (2009)

    Simply Effective Group Cognitive Behaviour Therapy: A Practitioner’s Guide (2012)

    Simply Effective Cognitive Behaviour Therapy Supervision (2013)

    Dr Mike Scott

  • But it is – despite what form the group takes Devilly et al (2026). For some the intervention is termed Critical Incident Stress Debriefing (CISD) and for others Psychological First Aid (PFA).

    I’ve just seen J ack who was savagely attacked by a dog. Understandably he had severe PTSD and was referred to routine psychological treatment. He underwent 6 group sessions of 90 minutes with 8-10 participants online. Jack said the group didn’t help at all, no discussion of personal trauma was allowed and he endured weekly education on PTSD via Powerpoint. My thoughts were ‘death by Powerpoint’.

    Devilly et al (2026 concluded ‘

    ‘a major problem is that the current study raises the possibility that PFA deleteriously affects the most highly distressed following traumatic events (similar to the debriefing literature) and should not be routinely administered. In large Western cultures, PFA workshops are currently being offered by the very institutions who are evaluating best practice. This practice may be borne out of a necessity to raise funds in a society that increasingly sees science as just one alternative to advancement and one where funds are routinely withheld from research institutes. However, it raises concern for both the intervention at a general level and the evaluation of it by those providing the training’.

    Groups are the answer to a Manager’s prayer, promising massive throughput. There is no doubt that perceived social support is a major predictor of outcome in the treatment of PTSD. But there is no evidence that this can be manufactured by simply putting all trauma victims together. When I was leading the BABCP special interest group, on group work I found an ideological belief in the value of groups. There was scant recognition that the evidence base for group CBT was diagnosis specific and limited [ see Simply Effective Group CBT Scott (2011)]. Low intensity workers were particularly scathing of the need for reliable diagnosis. Nothing it seemed should interfere with ‘getting people together’. Workshops have included ‘Transference and Groups’ . There has been an absence of critical appraisal and I have absented myself from the SIG.

    Dr Mike Scott

  • The modal response of NHS Talking Therapies is to usher trauma victims into a group treatment as soon as possible. Such treatments approximate to Psychological First Aid (PFA). It is justified by an appeal to the benefits of social support, active listening/empathy and psychoeducation, without the need to re-live their trauma.  But far from any evidence that it is evidence-based, a just published study by Devilly et al (2026) suggests that it is actually harmful.

    The predecessor of PFA was Critical Incident Stress Debriefing which was found to be harmful [see Scott (2022) Personalising Trauma Treatment: Reframing and Re-imagining London (Routledge)].  PFA and CISD have achieved enormous popularity, but so to did leeches. 

    Devilly et al (2026) suggest that the deleterious effects of these interventions arises from interfering with the natural process of recovery and that resilience is the norm. With 90% of people experiencing an extreme trauma in their lifetime that could lead to post-traumatic stress disorder, but only 6% of the population suffer long term debility. Devilly et al (2026 )argue for a personalised treatment from the outset. What currently occurs in NHS Talking Therapies is a manager’s dream, targetted at maximising throughput of clients. The Service is factory-like.

    Dr Mike Scott

  • This is the implication of a guest editorial in the British Journal of Psychiatry by Hollingdale, Woodhouse and Deeley (2026). But these authors are all involved in private diagnostic assessments, some of which are for the Courts, unsurprisingly their conclusions are therefore expressed more ‘measuredly’.  

    The elaborated shortcomings of the Autism assessment process could be applied to the spectrum of disorders under NHS England’s mental health umbrella:

    ‘there is considerable variation in the quality of assessments and associated reports within and between NHS services and private practice.9 For example, to reduce costs, some services may undertake only a brief autism-specific developmental history or use non-standardised, non-validated online observations. They may also employ less experienced professionals to administer complex assessment tools. Such clinicians may have less clinical experience and may not be trained in differential diagnosis. Other factors that may contribute to variation in diagnostic decisions include inconsistent determination of impairment as a component of diagnosis, perceived pressure to provide a diagnosis when individuals or families are paying high fees for assessments and differences in the weight given to self-report or family report compared with observable features required for a diagnosis’

    ‘Following assessment, comprehensive formulations and reports are recommended to inform support needs. However, to reduce time and associated costs, diagnostic letters with non-individualised recommendations may be provided as an alternative. Robust individual formulations are essential not only for those diagnosed with autism but also for those who do not meet diagnostic criteria, as subthreshold autistic characteristics or alternative diagnoses may be more relevant to their current or future mental health and adaptive functioning. Ultimately, given recent changes to assessment methods in response to increasing demand, the clinical quality of many autism assessments may be at risk’

    They conclude:

    ‘This emphasises the importance of ensuring that comprehensive and robust assessments, including a suitable screening and triage process, are conducted by suitably trained, qualified and experienced professionals. Adequate time should be allocated to ensure that comprehensive reports are produced, differential diagnoses are considered and bespoke care plans are developed. While recommendations and guidelines exist, quality control procedures could be introduced to prevent future harm to individuals and negative implications for services’. 

    There is a desperate need for a re-think across the spectrum of disorders Not to do this is as calamitous as ignoring climate change. 

    Dr Mike 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