The number of cases of adult anxiety and depression has steadily increased over the past 12 years [Gkitakou et al (2025]). So, to have the number of cases of ADHD. The response of mental health professionals has been to call for greater funding of mental health. But there is sparse evidence that psychological treatment has had a significant impact on the prevalence of mental disorder – the treatment-prevalence paradox. The UK is struggling to balance the books, on what basis should mental heath services be exempt from the axe?
Much of routine psychological treatment is bogus. For example, no fidelity checks have taken place in NHS Talking Therapies to ensure that therapists actually deliver the alleged CBT. There is a long history of treatments being very popular but impotent. At the turn of the millenium debriefing was in vogue, but it was found that it increased the likelihood of developing PTSD rather than decreased it, [Bisson et al (1997)]. More recently in 2014 the bestseller ‘The Body Keeps the Score’ was published. The central claim was the trauma causes lasting neurobiological damage and that body-based treatments are uniquely effective, in that they lead to a successful processing of the trauma. Scheeringa’s (2025) review of the evidence suggests otherwise, none of them have been superior to CBT. Nevertheless, practitioner workshops on body-based treatments abound – the power of marketing.
Last night I attended a 3-hour workshop by Prof Popiel, from the University of Warsaw, Personalising PTSD Treatment: Self-Efficacy Focussed Cognitive Therapy. She addressed the issue what can be done if a client does not want to engage in re-living their trauma as part of PTSD treatment. Prof Popiel has developed her own non-trauma focussed treatment and found it as efficacious as prolonged exposure. Research centres are very good at developing new treatments, but the context in which they are developed often causes translation problems for routine practice. Her protocol drew on just about every CBT strategy with rigorous stipulation of weekly homework assignments in the 10-session programme. But there was no acknowledgement that such homework assignments are nowhere to be found in routine practice. She further suggested that by assessing the temperament of the PTSD sufferer they might be better matched to the appropriate treatment. This sounds all well and good, but where is the routine practitioner going to find the time to forage in temperament scales and apply them? There was a bewildering array of forms to be completed by the client, such as thought records and material to be read. Some PTSD suffers may not have concentration problems and some may be highly educated but I rarely encounter these groups in routine practise. Doubtless they are commonplace at University Research Centres. Despite her new treatment protocol Prof Popiel remains a devotee of trauma-focused therapy for PTSD. It appears to have escaped her notice that the most plausible explanation of the equivalence of the two treatment modalities that she examined, is that to the extent that they have worked, they have altered the centrality that the PTSD sufferer has accorded to their trauma.
Centrality is a feature of ordinary autobiographical memory, and there is no compelling reason to believe that traumatic memory is outside its’ range of application. I have detailed a centrality approach in my clinician handbook ‘Personalising Trauma Treatment: Reframing and Reimagining’ (2022) London: Routledge and my self-help book “Moving On After Trauma’ 2nd Edition London: Routledge (2024). Offering a user-friendly scaleable treatment.
Dr Mike Scott
Scheeringa, M. S. (2025). Evaluating evidence behind popular trauma narratives: neurobiological and treatment claims in The Body Keeps the Score. BJPsych Bulletin, 1–3. doi:10.1192/bjb.2025.10174
