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Key points
- It is important to get strong evidence that specific psychotherapies are effective.
- That can be hard to do, as standard trials are expensive to run and not always suitable for therapy methods.
- A recent trial of human givens therapy fits new, more stringent criteria for real-world evidence.
“My husband wants to know how we can be sure this has worked,” says Ellen.
I regard her as she sits comfortably opposite me, body relaxed, eyes sparkling, hair gleaming, and mood vivacious – light years away from the depressed, tense, somewhat unkempt person who first came to see me a month previously.
I was reminded of an anecdote that Ivan Tyrrell, co-founder of the human givens approach, used to tell about the day when, at a training session on our rewind detraumatisation technique, someone who had shaken with terror when describing their lifelong claustrophobia had, after a 30 minute-treatment, gone up and down alone in the training centre lift and was witnessed emerging with a beam from ear to ear.
“This is all very well,” bleated a doctor who was watching, “but how do we know this method works?”
Sometimes people ask these questions in the face of impressive proof because they really mean, as Ellen’s husband probably did, “How can we be sure the problem won’t come back again?” Thrilled as he no doubt was to have his lively, lovely wife back, he was frightened of recurrence.
Depression, compulsive behaviour, and so on are vulnerabilities and thus very likely to come back, if life gets too stressful. Human givens practitioners teach clients to be alert to that; to view the stirrings of old symptoms as a message that certain important needs are not being met; and to look to fix those, while applying the powerful coping techniques we have shown them.
But the doctor who queried the curing of the lift phobia more likely wanted to know whether there was statistical evidence to support the method; to know that it was not a one-off success but something that could be shown to be reliable over very many applications.
Understandably, before interventions can be advocated widely, there has to be measurable evidence. Randomised controlled trials (RCTs) are still the gold standard. Developed initially to test new drugs against older versions, RCTs in psychotherapy require a ‘treatment group’ to be compared with a ‘control group’ – a similar group of people who, most commonly, are merely followed up while they remain on a waiting list. Sadly, most therapy providers can’t manage that.
Problem 1: There must be identical delivery of the intervention to all in the treatment group, and that is certainly not how human givens practitioners do therapy. We tailor to the individual, so people with the same diagnosis might receive significantly different treatments.
Problem 2: Sometimes it will be unethical to leave unwell people on a waiting list, so bang goes the control group.
Problem 3: It may be completely unfeasible, financially and organisationally, for small bodies to carry out an RCT, which costs hundreds of thousands of pounds.
So it is wonderful that NICE, the National Institute for Health and Care Excellence, whose guidelines are followed closely by public prescribing bodies, last June published a framework for including real-world evidence into their deliberations about what treatments work best.1
As they explain it: “We want to use real-world data [routinely collected during treatments] to resolve gaps in knowledge and drive forward access to innovations for patients.” Their framework sets out stringent requirements to ensure that the evidence collected is of high standard, and that the means of collection is transparent and avoids bias.
It just so turns out that a practice-based study of human givens therapy, which started in April last year, ticks every one of NICE’s real-world framework boxes. Called Project-100, it was devised by Bill Andrews, co-originator of the outcome-tracking tool Pragmatic Tracker2 and an honorary researcher at the University of Roehampton. It is a study of the impact of completed human givens therapy on military veterans seeking help for psychological trauma from the charity PTSD Resolution. Its study design, research and recording methods, range of outcome measures used to rate progress, length of follow-up, and availability of full data for other researchers to access, etc., are all in accord with NICE’s requirements.
Just over a year on, there are already full data for 174 clients (far exceeding the original 100 completed cases aimed for); three-quarters of clients stayed in treatment until an agreed planned ending – an extremely high number, compared with those referred to psychotherapy through the nationwide Improving Access to Psychological Therapies (IAPT) programme – while recovery rates were largely equivalent to the ambitious targets which IAPT aims for.3 All this is in the process of being written up for publication in a peer-reviewed academic journal.
Veterans bring with them real-world problems, writ large. It may be years before they find their way into therapy, by which time, alongside psychological trauma, they may be experiencing high general anxiety, depression, addiction, and difficulties with anger and aggression, exacerbated by struggling to fit back into civil society, and all causing family upset and relationship breakdown, often leading to homelessness.
So it seems highly likely that the methods used by human givens therapists that have been shown to help veterans are just as successful in helping other clients who seek our help every week.
That might further reassure Ellen’s husband, and even satisfy the doctor sceptical about the phobia cure.
References
1 NICE real-world evidence framework https://www.nice.org.uk/corporate/ecd9/chapter/overview
