Michael J Scott

  • If you wanted to market AI therapy such as ChatGPT, the developers should follow NHS Talking Therapies lead:

    • Make what you are trying to measure is opaque/fuzzy e.g difficulties
    • Re-administer the same measures (PHQ-9 and GAD-7) some time later
    • Wait until there is a large reduction in score
    • Claim that this person has recovered or at least moved in the direction of recovery

    Repeat the analysis a million plus viewers. You can then present the case that AI works. Further that as NHS Talking Therapies cannot refute the claim, they should move over and make space for the cheaper more accessible AI – hoisted by their own petard.  

    Haemorrhaging at NHS Talking Therapies

    1.81 people contacted NHS Talking Therapies , according to the latest annual report https://www.google.com/goto?url=CAEStgEB6zswFbaxup-Ub0l-S3XIZberh7NvPgVk0BN6i2g3_VDsWmCEQuNeY8DtHkI7s3_6fYlwBwBiJrB7yRx3c1RHq7TJ_8VQm5050UN7KeKlGs9AbZsPAzZp9eng1tbfYevALTl5xUiVcz_TL0W_WJS1G6veme5UnBm1Iq-NzyPvubSEbqxtwcdzTbcly5bDayHbIQEZQADJARLdRaTN4Y6kThugiA5xTO95WrZy3bX8nmEG_EQShg but only 1.17 million accessed the service (presumably this means actually attended an appointment).  So 0.64 million  were lost to the Service i.e 35.4%. Thus approx a third of people go into the NHS Talking Therapies Shop  and leave without any engagement.

    674,683 completed treatment (2 or more sessions). Of those who attended an appointment (1.17 million) 495,317 did not complete treatment i.e 42.3 % . Thus NHS Talking Therapies alleged 50% recovery rate, applies to approximately the half of people who complete treatment. 

    NHS Talking Therapies ‘Works’ For a Fictitious Disorder!

    Of the completers 642,940 that had an initial PHQ 9 at 10 or above (caseness) their mean score reduced from 15.4 to 9.4, an effect size {ES) of 1.1, but for those with depression the ES was 1.4, for those with PTSD the ES was 1, for OCD 0.8 and for BDD 1.1, For mixed anxiety and depressive disorder the ES was 1.1. But there is no evidence based treatment for this ‘disorder’, it h as never been the focus of NICE. This suggests NHS Talking Therapies is not measuring anything real, it is simply picking up noise in the system that changes over time.

    Most Will Get A Bit Better With Time

    Whether it be those treated by ChatGPT, NHS Talking Therapies or attendance at the Citizens Advice Bureau. It is simply time, attention and expectancies that are responsible for the change, nothing to do with the alleged CBT that has been conducted.

    Treatment integrity checks have never been implemented in NHS Talking Therapies.

    D r Mike Scott

  • Today marks the publication of the NHS Talking Therapies annual report for 2025-2026. But it is not known who was treated with what. The NHS clinicians have simply asserted what they believe a person was suffering from and what treatment they provided. Making meaningful audit impossible.

    On the first page of the report it states ‘NHS Talking Therapies is run by the NHS in England and offers NICE-approved therapies for treating people with anxiety or depression’. But provides no evidence that NICE-approved protocols have been delivered in routine practice. No check on treatment integrity has been conducted.

    Imagine the furore if Amazon claimed all its’ parcels were successfully delivered!

    Alleged cognitive behaviour therapy (CBT) continues to be the mainstay of NHS Talking Therapies provision. CBT departed from traditional psychotherapy by becoming an explicitly psychoeducational form of therapy. But the Service has provided no documentary evidence of the routine setting and review of homework, despite the latter being linked to outcome [Kazantis et al 2017] r=0.26. Making CBT in practice a myth. As the Channel 4 documentary ‘The Great ADHD Myth’ demonstrated, myths can become pervasive and once the horse has bolted locking the stable door is a fraught endeavour. Neither NHS Talking Therapies or ADHD would stand up in a Court of law.

    Dr Mike Scott

  • That’s the claim by Hayes et al in the most recent issue of the Clinical Psychology Review. These authors damn with faint praise a body of knowledge that asserts ‘what psychological treatment works for which clients in which circumstances’. This has been the foundation for the NICE guidance on evidence-based protocols for depression and the anxiety disorders.

    Hayes et al (2026) present a caricature of manual based protocols as if the diagnostic label necessitates a slavish adherence to a protocol. When a reliable diagnosis was only ever intended as a starting point. Aaron Beck was quite explicit that before beginning treatment it was necessary to distil a case formulation i.e the specific way in which the person’s difficulties are an expression of the cognitive model of a disorder. For example for one depressed person their depression might be linked an excessive demand for approval whilst for another person it might be linked to achievement. The different pathways lead to a different focus. There is a personalisation of treatment.

    These authors assert that everybody is unique and imply that this confers worth. But this is a contestable philosophical proposition. No scientific experiment can demonstrate the worth of a person.

    They object to the categorisation of clients, in particular that the DSM’s pigeon-holing of clients is close to an abomination. But this is an over-interpretation of diagnosis, nobody disputes that co-mobidity is the norm. However this presents no obstacle to interweaving protocols for the identified disorders Scott (2009).

    Hayes et al (2026) point out that only a significant minority of people ( at most 50%) recover with an ‘evidence-based treatment’. But attribute this to a lack of personalisation of treatment. They make no mention that the recovery rate in routine NHS psychological treatment is of the order of 10-15%, Scott (2018). Further its’ clinicians are not trained to diagnose. We thus have a natural experiment of what happens when clinicians operate on their own unique (idiosyncratic) formulation.

    The approach of Hayes et al (2026) is nebulous and not dissipated by calls for clients to utilise wearable devices and call on AI.

    The idea that ‘one size fits none’ lacks face validity, a shop selling only one size of shoe will hit the mark with some customers. Alternatively the shop owner might announce ‘we ‘don’t do sizes, let’s go with what you feel comfortable with’ but a customer might think that they have better things to do than spend all day trying on shoes. I have suggested that the modal response of NHS Talking Therapies clients is ‘Thanks, but no thanks’ Scott (2025).

    Dr Mike Scott

  • Once a mental heath construct captures public consciousness it is extremely difficult to shift. Organisations develop to promote and extend the narrative. Dissenters are like King Canute trying to hold back the waters.

    Into the path of the ADHD juggernaut has stepped the Channel 4 documentary ‘The Great ADHD Myth’. With a positive balanced critique of the documentary by clinical psychologist, Yaakov Ophir (2026). Unsurprisingly it has brought down the wrath of ADHD UK,but with no credible rebuttal.

    The British Association of Cognitive and Behavioural Psychotherapy (BABCP) is the self-proclaimed lead organisation for CBT in the UK. But it has maintained a deafening silence, about the CBT treatment of ADHD. Embarrassingly there is no evidence- based protocol for this ‘disorder’. Yet ADHD figures prominently in GP records with young and old being placed on the ADHD pathway. Parents are led to believe that there is a ‘pot of gold’ at the end of these rainbows.

    Back in the 1980’s I ran groups for parents stressed out managing their kids [Scott (1989) and (2015)] but without any need to pathologise the children’s behaviour. Simple strategies applied systematically often worked wonders. But since there has been an absence of the application of simple 1st line strategies. Instead CBT therapists are invited to workshops that highlight the ‘complexity’ of problems, and that stress the miraculous properties of ‘formulation’. The more that problems can be reified, the more they can be held to fall within the orbit of academic clinicians – the predominant workshop providers.

    Workshops on PTSD are commonly based on the postulate that 

    arrested information processing at the time of the trauma is pivotal in the development of subsequent debility. It has become an article of faith. The more plausible perspective is that it is the centrality accorded to the trauma that results in the persistence of symptoms. But this alternative perspective, which is more conducive to dissemination than ‘re-living’, doesn’t get a look in [Scott (2022)]. Arrested information processing is another mental health juggernaut.

    Sometimes the data don’t allow us to be definitive. Many supporters of Critical Psychiatry would put ADHD and Autism in the same category. Having just read Jason Arday’s autobiography (up to 2023), it is difficult to escape the sense that something at a fundamental biological level has been going on with him. There seems to have been an overlap between autism and learning difficulties, which is mind-blowing as he rose to become the youngest black professor at Cambridge University. His death is a tragedy at every level, he clearly struggled valiantly (RIP).

    Dr Mike Scott

  • 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

  • But it is – despite what form the group takes Devilly et al (2026). For some the intervention is termed Critical Incident Stress Debriefing (CISD) and for others Psychological First Aid (PFA).

    I’ve just seen J ack who was savagely attacked by a dog. Understandably he had severe PTSD and was referred to routine psychological treatment. He underwent 6 group sessions of 90 minutes with 8-10 participants online. Jack said the group didn’t help at all, no discussion of personal trauma was allowed and he endured weekly education on PTSD via Powerpoint. My thoughts were ‘death by Powerpoint’.

    Devilly et al (2026 concluded ‘

    ‘a major problem is that the current study raises the possibility that PFA deleteriously affects the most highly distressed following traumatic events (similar to the debriefing literature) and should not be routinely administered. In large Western cultures, PFA workshops are currently being offered by the very institutions who are evaluating best practice. This practice may be borne out of a necessity to raise funds in a society that increasingly sees science as just one alternative to advancement and one where funds are routinely withheld from research institutes. However, it raises concern for both the intervention at a general level and the evaluation of it by those providing the training’.

    Groups are the answer to a Manager’s prayer, promising massive throughput. There is no doubt that perceived social support is a major predictor of outcome in the treatment of PTSD. But there is no evidence that this can be manufactured by simply putting all trauma victims together. When I was leading the BABCP special interest group, on group work I found an ideological belief in the value of groups. There was scant recognition that the evidence base for group CBT was diagnosis specific and limited [ see Simply Effective Group CBT Scott (2011)]. Low intensity workers were particularly scathing of the need for reliable diagnosis. Nothing it seemed should interfere with ‘getting people together’. Workshops have included ‘Transference and Groups’ . There has been an absence of critical appraisal and I have absented myself from the SIG.

    Dr Mike Scott

  • The modal response of NHS Talking Therapies is to usher trauma victims into a group treatment as soon as possible. Such treatments approximate to Psychological First Aid (PFA). It is justified by an appeal to the benefits of social support, active listening/empathy and psychoeducation, without the need to re-live their trauma.  But far from any evidence that it is evidence-based, a just published study by Devilly et al (2026) suggests that it is actually harmful.

    The predecessor of PFA was Critical Incident Stress Debriefing which was found to be harmful [see Scott (2022) Personalising Trauma Treatment: Reframing and Re-imagining London (Routledge)].  PFA and CISD have achieved enormous popularity, but so to did leeches. 

    Devilly et al (2026) suggest that the deleterious effects of these interventions arises from interfering with the natural process of recovery and that resilience is the norm. With 90% of people experiencing an extreme trauma in their lifetime that could lead to post-traumatic stress disorder, but only 6% of the population suffer long term debility. Devilly et al (2026 )argue for a personalised treatment from the outset. What currently occurs in NHS Talking Therapies is a manager’s dream, targetted at maximising throughput of clients. The Service is factory-like.

    Dr Mike Scott

  • This is the implication of a guest editorial in the British Journal of Psychiatry by Hollingdale, Woodhouse and Deeley (2026). But these authors are all involved in private diagnostic assessments, some of which are for the Courts, unsurprisingly their conclusions are therefore expressed more ‘measuredly’.  

    The elaborated shortcomings of the Autism assessment process could be applied to the spectrum of disorders under NHS England’s mental health umbrella:

    ‘there is considerable variation in the quality of assessments and associated reports within and between NHS services and private practice.9 For example, to reduce costs, some services may undertake only a brief autism-specific developmental history or use non-standardised, non-validated online observations. They may also employ less experienced professionals to administer complex assessment tools. Such clinicians may have less clinical experience and may not be trained in differential diagnosis. Other factors that may contribute to variation in diagnostic decisions include inconsistent determination of impairment as a component of diagnosis, perceived pressure to provide a diagnosis when individuals or families are paying high fees for assessments and differences in the weight given to self-report or family report compared with observable features required for a diagnosis’

    ‘Following assessment, comprehensive formulations and reports are recommended to inform support needs. However, to reduce time and associated costs, diagnostic letters with non-individualised recommendations may be provided as an alternative. Robust individual formulations are essential not only for those diagnosed with autism but also for those who do not meet diagnostic criteria, as subthreshold autistic characteristics or alternative diagnoses may be more relevant to their current or future mental health and adaptive functioning. Ultimately, given recent changes to assessment methods in response to increasing demand, the clinical quality of many autism assessments may be at risk’

    They conclude:

    ‘This emphasises the importance of ensuring that comprehensive and robust assessments, including a suitable screening and triage process, are conducted by suitably trained, qualified and experienced professionals. Adequate time should be allocated to ensure that comprehensive reports are produced, differential diagnoses are considered and bespoke care plans are developed. While recommendations and guidelines exist, quality control procedures could be introduced to prevent future harm to individuals and negative implications for services’. 

    There is a desperate need for a re-think across the spectrum of disorders Not to do this is as calamitous as ignoring climate change. 

    Dr Mike Scott

  • Over a decade ago, I wrote a trilogy of books under the ‘Simply Effective CBT’ umbrella. Starting with Simply Effective CBT [ Routledge 2009]. Then Simply Effective Group CBT Routledge 2012] and finally Suitably Effective CBT Supervision [Routledge 2013]. My idea was to aid in the dissemination of CBT by drawing on my real-world experience of delivering CBT. Despite the popularity of the books, the gales that have prevailed since publication have turned the umbrella inside out. Attempts to right the umbrella [ Towards a Mental Health System that Works , Routledge 2017] have failed and most recently in 2025, my abandonment of writing CBT Treatment Engagement for Routledge.

    The result has been disengagement from CBT, in ‘Thanks, But No Thanks’ published last year [Scott (2025)] I wrote with regards to NH S Talking Therapies:

    Almost half (45%) do not complete treatment, and for completers, the results are no better than for placebo. The diagnostic status of almost a third (29.1%) who attend just one session is unknown. The numbers of people who attend one assessment/ treatment session is approximately half of those who attend two or more treatment sessions, but the ratio varies by disorder.

    This has been met with radical apathy in the UK, but was met warmly by the Spanish Society of Clinical Psychology at their Annual meeting in Girona, Spain, May 2026 ‘All Talk and No Action’. 

    Last Saturday, over lunch I was trying to explain to a childhood school friend , a businessman, why it is that the UK Government has spent £2billion a year for almost 20 years, on NHS Talking Therapies/IAPT, without any independent audit. He looked at me with incredulity, a dip in the River Mersey seemed inviting.

    Dr Mike Scott




  • You wouldn’t think so with a likely 1000+ delegates, to the British Association of Cognitive and Behavioural Psychotherapies (BABCP) Annual get-together in 2 weeks time. But the key distinguishing feature of CBT, is the setting and review of homework. My inspection of 100’s of records [Scott (2026)] shows that it is conspicuously absent. ‘Alleged CBT’ abounds, but there is no documentary evidence that it takes place in routine practice. Whither accountability?

    CBT appears to mean whatever a therapist wants it to mean. So much for evidence-based CBT! There is a transdiagnostic version of CBT called the Unified Protocol, but there have been no sightings of homework associated with this, in the 100s of GP records that I have reviewed.

    It appears that we are invited to believe by the BABCP power-holders and Courses that CBT actually happens. Is CBT a Dodo?

    Dr Mike Scott