The NICE Depression Guidelines and the recovery model: Is there an evidence base for IAPT?

Background: The UK Improving Access to Psychological Therapies (IAPT) programme will roll out more Cognitive Behaviour Therapy (CBT) and perhaps other therapies on a large scale nationally and will provide a dramatic increase in CBT training. It is intended to deliver recovery outcomes such as return to work and improved functioning. The policy is partly based on recommendations in the NICE Guideline for Depression whose recommendations are based on a systematic review of symptom change, rather than recovery studies. Aims: To re-examine the NICE Guideline for Depression in terms of quality of life and functioning (QOL/F) change rather than symptom change to explore whether this provides the same base for the IAPT programme?s changes. Methods: A systematic review of QOL/F outcomes re-examining studies from the NICE Guideline systematic review of psychological treatments. Results: A minority of studies included in the NICE review used QOL/F measures. For those that did, the advantages of CBT and IPT found on symptom measures disappeared on QOL/F measures. Conclusions: The IAPT programme is not consistent with the recovery evidence base and there is a need for much basic and applied research on recovery change.