Helping clients to get back in charge of their lives, with the confidence, calmness & self-sufficiency to flourish.

Anxiety UK therapy outcomes for 2016

Anxiety UK have published figures for therapy outcomes in 2016, measured using the IAPT method for calculating recovery, reliable improvement and reliable recovery.

Out of 221 planned completions, 67% of clients recovered, 87% reliably improved and 67% reliably recovered.
This compares very favourably to the national IAPT outcomes for 2015/16 which were 46.3% recovered, 62.2% reliably improved and 44% reliable recovery.
Just to be clear, these figures relate to all forms of therapy provided through Anxiety UK's approved therapist schemes, working with CBT or hypnotherapy. I think they show the quality of the service and support that Anxiety UK are able to offer their members through the scheme.

For any one who is curious, the IAPT method for calculating recovery, reliable improvement and reliable recovery is as follows:

A referral is classed as ‘recovered’ if the client has finished a course of treatment and moved from caseness* to not being at caseness by the end of the referral.

A referral is deemed to have shown reliable improvement if it shows a decrease in one or both assessment scores that surpass the measurement error, (for GAD7 assessment this is 4, for PHQ9 it is 6).

Reliable improvement and recovery can be combined to create an overall measure of reliable recovery where both a change from caseness to not caseness during the course of the referral and which show reliable improvement.

*Caseness is the term used to describe a referral that scores highly enough on measures of depression and anxiety to be classed as a clinical case.

More information on the use of IAPT services can be found in this report.

Difficult decisions, challenging choices.

In our lives we’re presented with a constant stream of choices that require us to make decisions, thankfully most of them are not too difficult: Should I take the bus to work, or should I walk? Perhaps we have a preference to walk, as we’re trying to lose weight or keep fit, making it an easy choice, or perhaps it’s raining, which may make it an equally obvious choice.

As a result, it’s not surprising that we come to think of decisions as having one choice that is ultimately right, and one that is ultimately wrong, and we apply this kind of logic to all choices that we’re presented with. In fact, if life was this simple we’d all become quite robotic, as we follow logic and reason every step of the way. But difficult decisions present us with a different situation, one where the simple right/wrong, yes/no logic doesn’t apply, yet we so often fail to see that this is the case. Why?

Much of the time, a decision is difficult because it doesn’t have an obvious ‘right’ answer, and yet, whilst we might already realise this, we continue to review the options, think through the outcomes, and become frustrated by our inability to find the ‘right’ answer, even though we already know it does not exist! No wonder we so often feel we’re driving ourselves crazy in the process, as we endlessly think through our options, changing our mind again and again.

In such moments in can be helpful to recognise that the choice we’re considering doesn’t have a right/wrong answer, it simply has two different answers, each of which is right or wrong in similar measures. Perhaps both offer us the potential to be happy with the outcome of our choice, but in different ways. Let’s say the choice is between continuing to follow a career path as an employee or setting up a business of our own. In fact, each may offer a similar potential for future success, satisfaction and happiness: We just need to be comfortable enough to become the person that is better suited to the outcome we choose. In a sense, we go on to create the reason to have made that choice, after we’ve made the choice. In reality, this is a really empowering moment, one when we get to look inside ourselves for the reason and logic behind a choice, rather than searching outside.

In this way, we can come to see difficult decisions as those moments when we actually get to write the story of our life, rather than just drifting from one easy choice to the next.

Another reason we can find it so difficult to make the right decision is something psychologists call ‘affective forecasting’ - predicting how our emotional state will be in the future. But that’ll become the subject of another post…

False Memories…. when story and history get confused.

Many people still believe memories to be like video recordings, or filing cabinets containing perfect, detailed records laid down as events occur, and hopefully ready to be recalled at any time. Sure, we sometimes forget, or have hazy memory, but we believe that all those clear memories we have represent ‘perfect’ recordings of historical fact. However, research tells a very different story, which starts with the way we perceive the world: We take in a limited amount of information, which is then expanded and interpreted, based on our past experiences and cognitive biases, and becomes something we experience as an objective reality. The question of perception itself is a big subject, but it’s just the error-prone starting point for memories.

Our brains only record a small amount of our moment-by-moment experience in long-term memory, yet we tend not to experience memories as partial. In fact we ‘reconstruct’ memories when we recall them, and this process can easily cause memories to change over time, in a way that is imperceptible to us. A detail gets changed or added, extracts from other memories become combined, the chronology changes, and we may even add details that other people have told us about. But when we access that memory, it’s as if this was exactly how it was originally created. It feels completely true and accurate. These factors become particularly important when someone is being asked to recall a memory: If they are allowed to report what they remember, the result will be more accurate than if they keep being asked about details, which may lead to erroneous elements being added to the memory.

Psychologist Elizabeth Loftus studies false memories, and has been involved in conducting some of the most well known research in this field. One piece of research illustrated the hazards of leading questions in criminal prosecutions: People were shown a simulated accident and subsequently asked either the speed the cars were going when they ‘hit’ each other, or the speed they were going when they ‘smashed’ into each other. When the word ‘hit’ was used, witnesses considered the car’s speed to be 34 mph on average, but when the word ‘smashed’ was used, they recalled a higher speed of 41 mph. Furthermore, when the word ‘smashed’ was used, 32% of the people said they remembered seeing broken glass, against 14% who claimed to have seen broken glass when the word ‘hit’ was used. There was no broken glass.

The ways in which memories can be altered or contaminated by leading questions, or even conversations between witnesses, obviously raises may issues in criminal investigations and prosecutions, and it’s in this field that people became very interested in using hypnosis to ‘improve’ access to memories. The Los Angeles Police Department trained detectives to use hypnosis with both suspects and witnesses, and the officers became known as the ’Svengali Squads’. Perhaps the most dramatic success came in 1976 with the ‘Chowchilla’ kidnapping: Twenty-six children and a school bus driver were kidnapped by three men, but managed to escape after spending some time partially buried in a quarry. Under hypnosis the bus driver remembered the licence plate of one of the vehicles involved in the abduction, which led the police to detain the men responsible. However, the use of hypnosis did not prove to be a turning point in the fight against crime, and there were equally noteworthy failures. What was particularly significant on this occasion was that the driver had attempted to memorise the licence plate at the time of the abduction; the information had been encoded in memory.

Although there is still some debate on the subject, it seems there is little evidence that hypnosis makes memories more reliable as such, and although it can seemingly enhance memory access, it can also enhance all the errors that naturally occur in our memory; those ‘added details’, distortions and confusions. It’s like turning up a signal and getting more noise too. As a result, the pendulum has swung the other way in many places, including the UK where Home Office guidelines warn that evidence obtained under hypnosis is likely to be inadmissible in court.

Of course, this also raises questions about the use of memories in psychotherapy, and also the use of hypnosis to access memories in therapy. In fact, this was the subject of some pretty fierce fighting in the 80s and 90s, sometimes referred to as the ‘memory wars’. Elizabeth Loftus was on the receiving end of some of the hostility, for speaking out on the subject of false memories in therapy, something she discusses in her TED Talk linked below. Michael Yapko, clinical psychologist and author on the subject of clinical hypnosis, has written about this episode on a number of occasions, explaining that therapists used a range of techniques (including hypnosis) to ‘uncover’ repressed memories of childhood abuse. Unfortunately many of the therapists had no idea that digging deeply for memories of abuse could result in the creation of false memories. Inevitably, the results were disastrous for individuals, with families being torn apart, and on occasions innocent people stood accused in courtrooms.

Thankfully, the issues around false memories are better understood today, and psychotherapists can be expected to work with memories in ways that are not directive and do not involve suggestion. They should ensure their clients understand that memories would need to be independently corroborated, before they can be considered to have any historical accuracy, no matter how real they feel. But most often in therapy, unlike forensics, it’s the narrative truth that really matters. It’s the story we carry with us that influences how we think, feel and act, not the historical truth. Imagine a parent telling a child that they’ll get a great reward if they do well at school: The historical truth may be that the parent simply wanted their child to have the best opportunities in life, but if the child heard ‘I’ll only love you if you’re clever’, they may be left with a feeling of rejection, rather than unconditional love, and that is the story they will carry.

So, ultimately, memory is pretty unreliable when it comes to providing any historical truth, regardless of the fact that it feels so convincingly true. But, despite it’s inherent inaccuracy it forms the basis of our story, and fuels our thoughts, feelings and actions. Thus it can directly influence our present and our future.


See the TED Talk by Elizabeth Loftus here.