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