Coping with anxiety – on the cheap

Should I be worried at being treated by what can best be described as a
barefoot doctor?

Our therapist is part of a radical programme known as IAPT (Improved Access to
Psychological Treatments), which approaches its fifth anniversary this
month. It was launched by the Department of Health in 2007, with an initial
investment of more than £300 million to train up to 4,000 CBT therapists by
2014. While about half of those trained will be mental health professionals
who will deal with more severe cases, the rest are like the young woman
above – mostly graduates, some with psychology degrees, recruited by private
companies to treat those with milder problems. They will be teaching CBT
under supervision, in classes of up to 25, four days a week – with a fifth
day in college for a year, to learn the theory.

IAPT is now available in nearly all of England’s 151 primary care trusts (but
not in Scotland or Wales). And the latest figures show that about 45 per
cent of those treated under the programme have “moved towards recovery”.
Which sounds impressive – but can psychological treatment from a graduate
without any credentials be trusted? Or is there something disturbing about
this approach to mental health?

I’m aware that CBT is radically different to traditional psychotherapy. So I
wasn’t expecting a darkened room with a Sigmund Freud lookalike asking
questions about my childhood as I lay on a velvet couch. But I did expect to
be welcomed by name, and for the pain that had brought me to this room to be
acknowledged in some way. As it was, we could have been invited in off the
street to be trained to sell soap.

During the six weeks of the course, we galloped through CBT theory, as the two
practitioners read out at breakneck speed fact sheets on things such as
eight “unhelpful thinking styles” and 10 tips on how to combat them. Nor did
they prove that great at people skills: I can’t tell you the names of those
who taught the group because I was never told them – and I’m certain they
didn’t know mine.

There were good moments – when we were able to discuss in small groups our
tendency to have “catastrophic thoughts”, and other classic symptoms of
anxiety. The chance to share our vulnerabilities was welcome, an opportunity
to laugh at ourselves and even shed the odd tear. But such confessional
moments were quickly brought to a close as the practitioner’s eyes glazed
over or she stared pointedly at the clock. The message was clear: “Keep it
brief. We’ve got a lot of fact sheets to get through.”

Perhaps I was just unlucky. It’s widely accepted that the pile ’em high
approach to mental health care varies in quality, not least because the
sector is recruited and trained by private companies with little central

“It is important that all practitioners have high-quality training – and we
believe there have been instances where the programme has not been delivered
as intended,” says Dr David Murphy, chair of the British Psychological
Society’s professional practice board.

Nicky Lidbetter, chief executive of the charity Anxiety UK, says one problem
is the type of people being recruited as practitioners. The idea was to
recruit people who had themselves suffered from anxiety or depression.
Instead, she says, “most companies are recruiting new graduates with little
life experience and no sense of the problems faced by patients”. High
turnover of practitioners is another problem, according to the Department of

Yet despite my doubts, I am one of those who has “moved to recovery” after
taking a CBT course. At some point, something clicked and I was able to stop
the destructive worrying, in much the same way as I stopped smoking a few
years ago with hypnotherapy. The exercises undoubtedly helped me not only to
understand my anxiety, but also to experiment with strategies such as
distraction techniques and breathing exercises.

Dr Paul Blenkiron, a consultant psychiatrist at Bootham Park Hospital in York
with a special interest in CBT, argues that it is essentially a
do-it-yourself therapy whose success depends on the patient’s commitment to
put in the hard work themselves, rather than on professional expertise.

“For the majority of people, Psychological Wellbeing Practitioners can provide
the guided self-help that people need to succeed with CBT – while more
complex or severe cases can be referred upwards,” he says.

Yet I still wonder what happened to the people who came just once to the
course I attended, before dropping out. And while most people who completed
it claimed they’d benefited from it at our final celebration in the pub, I
wonder how many are still feeling like that several months on.

Prof David Clark, from Oxford University, who helped put together the IAPT
programme, believes that booster sessions should be available when needed.
“It’s easy to slip back into old habits at times of stress, and that needs
to be recognised,” he says.

And me? I’m grateful that CBT has calmed the unnecessary clutter in my head,
leaving me with a better quality of life – and calmer holidays. But I still
feel those Psychological Wellbeing Practitioners should stop behaving as if
each session were a race against the clock – and show a little more
compassion and understanding.

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