La Fantasía de las Terapias Conversacionales del NHS en Reino Unido
Contenido principal del artículo
Resumen
En febrero de 2023, el programa del National Health System (NHS) inglés Improving Access to Psychological Therapies (IAPT) fue rebautizado como NHS Talking Therapies, aunque este cambio no se tradujo en mejoras sustanciales que indiquen un avance en la calidad del servicio. El propósito fundamental de este artículo es realizar una evaluación crítica de los mitos perpetuados por el IAPT (ahora NHS Talking Therapies). A pesar de la sorprendente campaña de marketing de NHS Talking Therapies, no parece haberse logrado reducir la carga de salud mental en el Reino Unido. El programa se ha confirmado como un mero canal en la aplicación de protocolos respaldados por el National Institute for Health and Care Excellence, que se sostienen a través de una serie de mitos ampliamente discutidos y refutados en este trabajo. Sin utilizar criterios claros para determinar si un tratamiento psicológico está apoyado empíricamente, es probable que los países caigan presa de intervenciones farmacológicas o psicológicas bien comercializadas. Ante tal ausencia de control, los proveedores de servicios de salud tendrían licencia para malgastar el dinero, dejando las necesidades de la población en segundo plano.
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Esta licencia permite copiar y distribuir el material en cualquier medio o formato sin adaptarlo, únicamente con fines no comerciales y siempre que se reconozca al autor.
Citas
American Psychiatric Association. (2023). Manual diagnóstico y estadístico de los trastornos mentales. (5ª ed. revisada). Editorial Médica Panamericana.
Barkham, M., & Saxon, D. (2018). The effectiveness of high-intensity CBT and counselling alone and following low-intensity CBT: a reanalysis of the 2nd UK National Audit of Psychological Therapies data. BMC psychiatry, 18(1), 321. https://doi.org/10.1186/s12888-018-1899-0
Bower, P., & Rowland, N. (2006). Effectiveness and cost effectiveness of counselling in primary care. The Cochrane database of systematic reviews, (3), CD001025. https://doi.org/10.1002/14651858.CD001025.pub2
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., Shea, M. T., & Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. The American journal of psychiatry, 162(6), 1179–1187. https://doi.org/10.1176/appi.ajp.162.6.1179
Carey B (2017, 24 de julio) England’s mental health experiment: No-cost talk therapy. The New York Times. Available at: https://www.nytimes.com/2017/07/24/health/england-mental-health- treatment-therapy.html.
Drew, P., Irvine, A., Barkham, M., Faija, C., Gellatly, J., Ardern, K., Armitage, J. C., Brooks, H., Rushton, K., Welsh, C., Bower, P., & Bee, P. (2021). Telephone delivery of psychological interventions: Balancing protocol with patient-centred care. Social science & medicine (1982), 277, 113818. https://doi.org/10.1016/j.socscimed.2021.113818
Faija, C. L., Bee, P., Lovell, K., Lidbetter, N., Gellatly, J., Ardern, K., Rushton, K., Brooks, H., McMillan, D., Armitage, C. J., Woodhouse, R., & Barkham, M. (2022). Using routine outcome measures as clinical process tools: Maximising the therapeutic yield in the IAPT programme when working remotely. Psychology and psychotherapy, 95(3), 820–837. https://doi.org/10.1111/papt.12400
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2016). User's guide for the SCID-5-CV Structured Clinical Interview for DSM-5® disorders: Clinical version. American Psychiatric Publishing, Inc.
Guidi, J., Brakemeier, E. L., Bockting, C. L. H., Cosci, F., Cuijpers, P., Jarrett, R. B., Linden, M., Marks, I., Peretti, C. S., Rafanelli, C., Rief, W., Schneider, S., Schnyder, U., Sensky, T., Tomba, E., Vazquez, C., Vieta, E., Zipfel, S., Wright, J. H., & Fava, G. A. (2018). Methodological Recommendations for Trials of Psychological Interventions. Psychotherapy and psychosomatics, 87(5), 276–284. https://doi.org/10.1159/000490574
Hepgul, N., King, S., Amarasinghe, M., Breen, G., Grant, N., Grey, N., Hotopf, M., Moran, P., Pariante, C. M., Tylee, A., Wingrove, J., Young, A. H., & Cleare, A. J. (2016). Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC psychiatry, 16, 52. https://doi.org/10.1186/s12888-016-0736-6
House of Commons Library. (2023). Mental health statistics: prevalence, services and funding in England. https://researchbriefings.files.parliament.uk/documents/SN06988/SN06988.pdf
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ‐9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
McManus S, Bebbington P, Jenkins R, & Brugha T. (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
National Collaborating Centre for Mental Health. (2021). Improving Access to Psychological Therapies Manual. Version 5. https://www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-manual/
National Collaborating Centre for Mental Health. (2023). Improving Access to Psychological Therapies Manual. Version 6. https://www.england.nhs.uk/wp-content/uploads/2018/06/the-nhs-talking-therapies-manual-v6.pdf
Nature (2012) Editorial: Therapy deficit. Nature 489(7417): 473–474. https://doi.org/10.1038/489473b
Owen, K., Laphan, A., Gee, B., & Lince, K. (2023). Evaluating cognitive analytic therapy within a primary care psychological therapy service. The British journal of clinical psychology, 62(3), 663–673. https://doi.org/10.1111/bjc.12430
Rushton, K., Fraser, C., Gellatly, J., Brooks, H., Bower, P., Armitage, C. J., Faija, C., Welsh, C., & Bee, P. (2019). A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service. BMC health services research, 19(1), 997. https://doi.org/10.1186/s12913-019-4824-4
Scott, M.J. (2009). Simply Effective Cognitive Behaviour Therapy: A Practitioner’s Guide. London: Routledge
Scott M. J. (2018). Transforming Improving Access to Psychological Therapies. Journal of health psychology, 23(9), 1163–1172. https://doi.org/10.1177/1359105318781873
Shafran, R., Myles-Hooton, P., Bennett, S., & Öst, L. G. (2021). The concept and definition of low intensity cognitive behaviour therapy. Behaviour research and therapy, 138, 103803. https://doi.org/10.1016/j.brat.2021.103803
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317–338. https://doi.org/10.1037/h0101729