Engaging With CBT

Tag: NHS Talking Therapies

  • Simply Ineffective CBT

    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




  • NHS Talking Therapies In The Melting Pot

    In March 2025 the government announced the end of NHS England within 2 years, with a move of staff and function to the Department of Health and Social Care. Integrated Care Boards, who oversee much of mental health provision, are being asked to achieve a 50% reduction in costs. Jobs are likely on the line. The pressure will be to avoid any ‘talking’ in favour of digital ‘solutions’ such as Silver Cloud. A recent exchange on Twitter highlights the extreme dissatisfaction with NHS Talking Therapies attempt to do things on the cheap! The paradox will be ‘talking therapies, don’t talk’.

    Psychological treatment is following an ‘entropy trajectory’, where energy becomes progressively available in a less useful form. The process starts off reasonably well, with randomised controlled trials showing CBT treatments are better than active control conditions, but a paucity of evidence on how long gains last. Further it is not clear what this means in the real-world.I have found it impossible to discover what proportion of those given CBT would say that they recovered in the sense of being back to their normal selves for what they would see as a meaningful period. When the rcts have been evaluated in routine practice , there has usually not been independent assessment. Thus whilst a case can be made that ‘efficacy’ is proven, not so for ‘effectiveness studies’. When it comes to routine practice the energy is further degraded, it is only the Service providers who claim a 50% recovery rate. My own independent analysis as an Expert Witness to the Court suggests a tip-of-the iceberg rate of recovery. Most likely explained by giving people simply time and attention rather than anything to do with CBT.

    Unfortunately, Service providers and lead organisations for CBT are likely to push as far as possible f or the retention of the status quo. But in w hose interest?

    Dr Mike Scott