Abstract
To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT). The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N=76) and CBT (N=73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies. LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between-therapy post-treatment effects and medium-to-large within-therapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower. Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed. Practitioners (under appropriate supervision) could use 8-session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8-session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity.
Highlights
When cognitive analytic therapy (CAT) was commenced in the Improving Access to Psychological Therapies (IAPT) service under study, the duration commissioned was 8 sessions, in order to match the length of intervention offered by other psychological therapists offering counselling interventions in the high intensity tier of the service
To be included in the study data set as a cognitive behavioural therapy (CBT) case, the case record was from a patient that received at least one and up to eight CBT sessions for anxiety or depression, and their baseline demographic and clinical characteristics were closely matched to those of the CAT cases
IAPT has been developing and evolving for over ten years with a marked innovation being the widening of choice and availability of evidence-based interventions (Wakefield et al, 2020)
Summary
To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and to compare outcomes with cognitive behavioural therapy (CBT). The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies. LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed
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