A recent editorial in Nature concerning therapy deficit and the urgent need to invest in research to enhance the effectiveness of psychological treatment is timely and may prove influential for our field.1 The piece used the example of the Improving Access to Psychological Therapies (IAPT) programme and the lack of resources to establish the causes of variation in outcome across a service that provides access to support to more than 600 000 people. We wish to alert interested researchers to a slightly more positive example: the Stop Smoking Services in England. These were established in 1998 to help address the single largest preventable cause of premature death in the country and now treat 800 000 smokers each year. Research has begun on establishing the aspects of support that account for the very large variation that exists between local services2 and specialist practitioners within services.3 The research has found, for example, that group-based treatment is linked to higher success rates than one-to-one treatment or drop-in clinics, and that services which use particular ‘behaviour change techniques’, such as showing smokers their expired-air carbon monoxide readings to boost motivation to stop, have higher success rates.4 This work has led to the development of competence assessment and training programmes (e.g. www.ncsct.co.uk),5 but it is only a beginning. Because it can make use of routinely collected, national data, this kind of research can continue to be carried out extremely cost-effectively and save many thousands of lives. However, significant additional funding is required to evaluate improved treatment programmes, based on findings such as these, by means of randomised controlled trials. We hope researchers who are interested in enhancing the psychological treatment provided by IAPT and similar programmes can learn from the early progress made on optimising the Stop Smoking Services.
- Royal College of Psychiatrists