Is there evidence for any other short term psychotherapy other than CBT?

Abstract

Background/Objectives: Cognitive Behaviour Therapy (CBT) is the most researched therapy with the largest evidence base. Only 50% of patients respond to CBT; drop-outs are frequent and CBT is not acceptable to all patients. Cognitive Analytic Therapy (CAT) was developed in response to the need for short-term therapies in the National Health Service in the UK. There are similarities between CAT and CBT and both are widely used in the UK public health service. Comparisons of CBT with other psychological therapies in anxiety and depression do not provide clear evidence for superiority due to both the limited number of studies and their heterogeneity. There is a relative shortage of head to head trials against non-CBT therapies and we need to introduce a research culture into a non-CBT psychotherapy setting. The aim of this feasibility trial is to build a foundation for a future, more definitive, explanatory head-to-head trial of CAT and CBT. The primary objective is to test whether CAT and CBT therapists can work together to identify patients who can be randomly allocated to either CAT or CBT; whether these patients can be recruited to a RCT and followed up and, lastly, whether the therapists can deliver their treatments in the context of a RCT. Methods: We aim to recruit 40 participants over a period of twelve months. We are recruiting patients who are of age 18 and above, suffering from symptoms of anxiety or depression (or both), assessed to need short-term specialist psychotherapy and suitable for either CAT or CBT in the opinion of an assessor. Those who consent to take part in the study are randomised to either CAT or CBT trial arm using stratification for age and gender. Data is collected through four structured interviews with patients administered by an independent researcher. Research assessments are conducted after a therapist's initial assessment, shortly before the start of the treatment, directly after treatment and six months after the therapy ends. Most treatments are scheduled for four months (16 weekly sessions). Results: Three CAT and four CBT therapists in local psychological services in Oxfordshire are identified and committed to the study. Issues on therapy model fidelity emerged among psychotherapists and became as relevant for the psychotherapists’ recruitment in the study. Recruitment of patients started in November 2010. Discussion/Conclusions: The findings of this feasibility study will help to establish a base for a larger, multi-site RCT of effectiveness of CAT versus CBT. Consequently this study will create a core group of therapists with experience in research who may establish a network of therapists ready to recruit their colleagues for the future explanatory trial of CAT against CBT. Funding: The Social Psychiatry Group, University of Oxford. Keywords: Evidence-based practice, feasibility study, psychotherapy.