I am aware that Cognitive Behavioural Therapy (CBT) sessions can be £100-£150 a time. With the course you were talking about earlier, that is a lot of money. Is price dictated by capacity in your sector?

Rose Aghdami:
Price does vary. The historical shortage of therapists means that clinical psychology places have been scarce. There have been many psychology graduates, so there was a bottleneck at the further training end, where there simply had not been enough spaces on clinical psychology training courses to cope with the demand and interest of people to continue in that profession.

That has been improved over recent years; there are more clinical psychology training courses available now. However, it will take time for those people to become experienced and qualified enough to be useful in catering in the need for CBT. You may have heard of Richard Layard's quote from last year: "10,000 more therapists needed now."

One way that the NHS is considering in trying to address this very real problem is to have a hub-and-spoke model, where people will be trained very specifically in CBT techniques for specific disorders.

If 40% of rehab is psychological, and we talk about stress being one of the greatest threats to insurers on future long-term liability issues, should we be spending so much time talking about the physical element of rehab?

Helen Merfield:
Musculoskeletal and stress between them count for the largest proportion of injuries. The difficulty is that you cannot separate out the physical and the psychological. If it is a physical injury, you need to look at the person to see if they have an accompanying psychological problem. If they have a purely physical injury, then they will be treated on the physical path. If they have more than that, they need to be treated along a slightly different path that combines CBT, physio or whatever treatment method.

What can often occur is that a straight-forward physical problem, if left untreated, can lead to secondary problems that become more difficult to address.

Imagine what happens if you damage your back. You are told to sit down and put your feet up; everyone brings you cups of tea and encourages you not to do much. This could go on for weeks; you might be encouraged not to do much and take time off work. As a consequence, you lose social contact with people, the reason to get up in the morning, the feeling of contributing and so on.

Not infrequently, depression sets in. When a person is depressed, they become moody. In the worst case, they develop a victim mindset, thinking 'Poor me, will it ever get better?' As they become depressed, they develop a negative perspective. We know depressed people feel pain more than others. This downward spiral continues.

You end up with something that in the first place was not such a big deal, but develops into a more sticky psychological problem. Those secondary difficulties can result from primary physical problems, and eventually become more difficult to shift. Early intervention on both levels is really crucial.