CBT training courses represent a marriage of private providers and Universities. The latter take their lead primarily from two professional organisations, the British Association for Behavioural and Cognitive Psychotherapy (BABCP) and the British Psychological Society (BPS). Both bodies lay claim to promoting evidence-based practise. Graduates of these courses are responsible for the psychological treatment of over 1,000,000 people a year, availing themselves of public and private services. The cost to the public purse for both adult and child mental health services is £2 billion a year.
But there has been no independent audit of whether this money is well spent. There is no evidence that it represents an added value over and above what was in place 20 years ago.
The CBT training courses are tasked with enabling students to manage the translation of the randomised control trials of depression and the anxiety disorders to routine practise. But there have been no effectiveness studies conducted to act as a guarantor of this translation. The training courses have undergone ‘mission creep’, such that students are now also taught how to manage ‘complex presentations’. However, the definition of this term is ‘woolly’ and the evidence base on which treatment rests is ill-defined. There is a suspicion of exaggerated claims. I am reminded of the comedy:
Service providers claim a 50% recovery rate based on changes on a psychometric test from the beginning to the end of treatment. But this evidence must be regarded as ‘weak’ at best: People tend to present at the worst and there is inevitably some improvement with the passage of time, “regression to the mean”. This is particularly the case if people are given attention. Additionally people do not wish to feel they’ve wasted their time and can remember their initial score, likely scoring less severely at the end of their therapeutic contact. Coupled with a desire to lease the therapist in front of them. Would they have done just as well attending the local Citizens Advice Bureau?
My own independent evidence Scott (2018), conducted on 90 everyday users of the Improving Access to Psychological Therapies service (the forerunner of NHS Talking Therapies) as an Expert Witness to the Court, and utilising a ‘gold standard’ diagnostic interview showed a “tip of the iceberg” level of recovery. Having reviewed further 157 litigants between 2019 and 2025 I could find no evidence in the GP records that cognitive behaviour therapy had actually been conducted. From its origins in the 1970s the hallmark of CBT has been the setting and review of homework. I have found no evidence that the ‘alleged CBT’ has happened, it would not ‘stand up in Court’.
To date CBT Training Courses have escaped public scrutiny, but the above considerations raise questions about their modus operandi. What is the total cost of CBT training courses? They are clearly good news for Universities, ‘bums on seats’, at a time of economic hardship. Further they extend the reach of professional bodies, validating courses and providing job opportunities for their membership. Self-interest mitigates against critical appraisal, consciously or not.
What effect does this have on students in the classroom? Does survival depend on toeing the party line? For example, a student re-iterating my claim of a 10% recovery rate in routine practice is likely skating on ‘thin-ice’. Too many quotes of my work and that of Dr Elizabeth Cotton is likely to incur the wrath of Course leaders. This may be followed by a ‘fishing expedition’ for misdemeanours such as use of incorrect political language and claims of poor scoring on the Cognitive Therapy Rating Scale. Protestations that the scale only has validity if the person meets diagnostic criteria for depression, is likely to be taken as further evidence of ‘awkwardness/incompetence’. This goes to the heart of whether the Universities are looking at academic freedom on CBT training courses or whether they are more concerned about budgets. What steps, if any, have Universities taken to ensure academic freedom on CBT training courses? What steps, if any have Service providers taken to ensure that students are not ‘bullied’ on CBT training courses?. Can courses evidence acceptance of a range of opinion on matters such as CBT’s superiority over other psychotherapies, the importance of formulation, the importance of diagnosis? Without this they are simply a conduit for the ‘movers and shakers’ in the professional bodies. Some students will be casualties of this oppressive culture, many others will mutter their misgivings in private.
Dr Mike Scott