Improving Access To Psychological Therapies Research Articles

Mental health outcomes in patients with a long-term condition: analysis of an Improving Access to Psychological Therapies service.

Having a long-term condition (LTC) significantly affects mental health. UK policy requires effective mental health provisions for patients with an LTC, generally provided by Improving Access to Psychological Therapies (IAPT) services. National IAPT data suggest that patients with an LTC typically demonstrate poorer outcomes compared with patients without an LTC. However, exploration of confounding factors and different outcome variables is limited. To establish the association of LTC status with demographic and clinical factors, and clinical mental health outcomes. Anonymised patient-level data from a London IAPT service during January 2019 to October 2020 were used in this cohort study, to compare differences between LTC and non-LTC groups on sociodemographic and clinical variables. Binary logistic and multiple linear regression models were constructed for binary outcome variables (recovery and reliable improvement) and continuous outcomes (distress and functioning), respectively. Patients with an LTC were more likely to be female; older; from a Black, mixed or other ethnic background; and have greater social deprivation. Across the four clinical outcomes (recovery, reliable improvement, final psychological distress and final functioning), having an LTC significantly predicted poorer outcomes even after controlling for sociodemographic and clinical baseline variables. For three outcome variables, greater social deprivation and being discharged during the COVID-19 pandemic also predicted poorer clinical outcomes. LTC status has a negative effect on mental health outcomes in IAPT services, independent of associated variables such as severity of baseline mental health symptoms, ethnicity and social deprivation. Effective psychological treatment for patients with an LTC remains an unresolved priority.

The acceptability of cognitive analytic guided self-help in an Improving Access to Psychological Therapies service.

An Improving Access to Psychological Therapies (IAPT) service in England has implemented cognitive analytic therapy guided self-help (CAT-GSH) alongside cognitive behavioural guided self-help (CBT-GSH) in order to support enhanced patient choice. This study sought to explore the acceptability to psychological wellbeing practitioners (PWPs) of delivering CAT-GSH. This study used a qualitative design with semi-structured interviews and associated thematic analysis (TA). A sample of n=12 PWPs experienced in delivering CAT-GSH were interviewed. Five over-arching themes (containing 12 subthemes) were identified and conceptually mapped: (a) the past-present focus (made up of working with clients' pasts and the different type of change work), (b) expanding the treatment offer (from the perspective of PWPs and clients), (c) the time and resources required to effectively deliver CAT-GSH (to enable safe and effective delivery for clients and personal/professional development for PWPs), (d) understanding CAT-GSH (made up of confidence, learning new therapeutic language/concepts and appreciating the difference with CBT-GSH) and (e) joint exploration (made up of therapeutic/supervisory relationships and enhanced collaboration). CAT-GSH appears an acceptable (but challenging) approach for PWPs to deliver in IAPT services. Services should prioritise training and supervision for PWPs to ensure good governance of delivery.

Using routine outcome measures as clinical process tools: Maximising the therapeutic yield in the IAPT programme when working remotely.

ObjectivesThe objective of the study was to investigate the administration and use of routine outcome monitoring session by session in the context of improving guided‐self‐help interventions when delivered remotely at Step 2 care in the English Improving Access to Psychological Therapies (IAPT) services.DesignQualitative research using recordings of telephone‐treatment sessions.MethodParticipants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one‐third sector organisation commissioned to deliver Step 2 IAPT services, in England. Data collection took place prior to the COVID‐19 pandemic. Transcripts of telephone–treatment sessions were analysed using thematic analysis.ResultsFour themes were identified: (1) lack of consistency in the administration of outcome measures (e.g. inconsistent wording); (2) outcome measures administered as a stand‐alone inflexible task (e.g. mechanical administration); (3) outcome measures as impersonal numbers (e.g. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. lack of therapeutic use of item and total scores).ConclusionsThe administration of outcome measures needs to ensure validity and reliability. Therapeutic yield from session‐by‐session outcome measures could be enhanced by focusing on three main areas: (1) adopting a collaborative conversational approach, (2) maximising the use of total and items scores and (3) integrating outcome measures with in‐session treatment decisions. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop‐out rates and improve clinical outcomes.

Effects of EMDR Group Traumatic Episode Protocol on Burnout Within IAPT Healthcare Professionals: A Feasibility and Acceptability Study

Mental health professionals face a high degree of burnout. This study aimed to explore the effectiveness of Eye Movement Desensitisation and Reprocessing Group Traumatic Episode Protocol (EMDR G-TEP) at reducing distress and burnout in staff working within an Improving Access to Psychological Therapies (IAPT) service and if outcomes changed over number of sessions attended. Twenty-two staff attended and measures examining burnout and subjective distress ratings of the targeted memory were taken pre- and post-intervention and at one-month follow-up. 95.5% reported finding the sessions helpful. A statistically significant reduction was observed on total burnout and on personal and work-related subscales; and a significant improvement in subjective units of disturbance was also observed. There was no interaction between changes in burnout and number of sessions attended. EMDR G-TEP has the potential to offer a novel method to improve staff wellbeing within mental health settings. Further research is recommended.

Views of services users and staff on a combined money advice and psychological therapy service within IAPT

Background Research has indicated that having financial difficulties may increase mental health problems and prevent recovery when receiving psychological treatment. A combined approach within the Improving Access to Psychological Therapies (IAPT) service could help clients by tackling their financial difficulties alongside supporting their mental health. Aims We aimed to explore the experiences and views of a potential combined intervention by speaking to IAPT service users who have/had experiences of money worries, as well as IAPT therapists and Citizen’s Advice (CA) money advisers. Method We conducted online semi-structured interviews with 16 IAPT service users, 14 IAPT therapists/practitioners, and 6 CA money advisors. Interviews were transcribed verbatim and analysed thematically. Results Themes discussed including the impact of money worries and mental health, the benefits of a combined intervention, how and when it should be introduced to clients and delivered, and how information should be shared between the services. It was felt by most participants that such an intervention would improve mental health and provide a more holistic service with a better referral pathway. Conclusions Our findings provide a blueprint for a combined money advice and psychological therapy service within IAPT, which both service users and staff identified would be beneficial.

Sexual minority service user perspectives on mental health treatment barriers to care and service improvements

Sexual minorities (individuals with a lesbian, gay, bisexual, queer, or other non-heterosexual identity) are at elevated risk of developing common mental health disorders relative to heterosexual people, yet have less favourable mental health service experiences and poorer treatment outcomes. We investigated the experiences of sexual minority service users accessing mental health services for common mental health problems (e.g. depression or anxiety) in the UK. We recruited 26 sexual minority adults with experiences of being referred to Improving Access to Psychological Therapies (IAPT) or primary care counselling services. Semi-structured interviews explored participants’ experiences of service use and views on service development. Interviews were analysed using thematic analysis. Barriers to effective relationships with practitioners included service users’ fears surrounding disclosure, and practitioners’ lack of understanding and/or neglect of discussions around sexuality. Regarding service development, participants highlighted the value of seeing practitioners with shared identities and experiences, visible signs of inclusivity, sexual minority training, tailored supports, and technological adjuncts. Our findings offer insights into possible contributory factors to treatment inequalities, and highlight potential methods for improving service provision for sexual minorities.

Four practice-based preliminary studies on Human Givens Rewind treatment for posttraumatic stress in Great Britain

Background: Human Givens (HG) Rewind is a relatively unknown trauma-focussed treatment. This paper aimed to provide preliminary evidence of the effectiveness of Rewind to treat posttraumatic stress (PTS) in a variety of clinical settings in Great Britain. Methods: An observational prospective design was used in each of the four studies. Standardised questionnaires were administered in every session. Pre- and post-treatment means and effect sizes were calculated for each study, as were ‘recovery rates’ and ‘reliable change’ rates. Results: Across four studies, a total of 274 clients completed treatment and had complete data. The data capture rate ranged from 80-100%. The mean pre-treatment scores were in the severe range. The pre-post treatment effects sizes ranged from 1.90-2.68. The percentage of clients who were below the clinical cut-off after treatment ranged from 46-56% for the more conservative lower cut-offs, and ranged between 71-82% for the higher clinical cut-offs as used by Improving Access to Psychological Therapies (IAPT). Across the four studies, 83-96% of clients had ‘reliably improved’ (88-94% on trauma-specific questionnaires), with 4-17% having no reliable change on those questionnaires. The mean number of HG treatment sessions ranged from 5-6.5 sessions (range 1–24 sessions), with between 73% and 84% of participants completing treatment in six sessions or less. Conclusions: These preliminary results indicate that HG Rewind appears to be a promising trauma treatment in a variety of settings. A randomised controlled trial is now required to determine the efficacy of this treatment.

Improving Access to Psychological Therapies in Spain: From IAPT to PsicAP.

Anxiety and depression are very prevalent in primary care, with high rates of chronic cases, comorbidity and lost quality of life, along with huge economic costs. The Improving Access to Psychological Therapies (IAPT) project, launched in the United Kingdom in 2007, has become an international benchmark for the treatment of common mental disorders. In Spain, Psicofundación developed the PsicAP clinical trial, following the precedent set by the IAPT. This study reviews and compares and contrasts the methods, results, and contributions of the IAPT and PsicAP. The IAPT is a project for the pragmatic implementation of evidence-based psychological therapies in primary care. PsicAP is a randomized clinical trial whose results demonstrated that adding a psychological treatment (seven group sessions of transdiagnostic cognitive-behavioural therapy) to treatment-as-usual (TAU) for anxiety and depression in the primary care setting was more effective and cost-effective than TAU alone. The therapeutic gains and the cost-effectiveness were maintained at a 12 months follow-up. Moreover, the percentage of reliably recovered patients was comparable to the numbers from the IAPT. This brief psychological treatment should be implemented in the Spanish public health system, similar to the precedent set by the IAPT initiative.

An evaluation of Anxiety UK's psychological therapy service outcomes

BackgroundAnxiety and depression are highly prevalent. The aim was to examine the effectiveness of Anxiety UK's national psychological therapy service; benchmarking against NHS IAPT data. MethodsWe examined psychological therapy outcome data for Anxiety UK clients who completed therapy between April 2019 – March 2020 and benchmarked this against NHS Improving Access to Psychological Therapies (IAPT) outcome data for the same period. Anxiety UK clients completed validated measures of anxiety and depression at two time points: the first and last therapy session. Caseness, recovery, reliable improvement and reliable recovery rates were based on IAPT definitions. Results957 clients completed at least two psychological therapy sessions with an Anxiety UK Approved Therapist. Recovery, reliable improvement, and reliably recovered rates exceeded IAPT targets. Depression and anxiety reduced from first to last session. Cognitive behavioural therapy produced the greatest change in anxiety over time compared to counselling and hypnotherapy. The more therapy sessions attended, the greater the change in anxiety and depression scores from the first to last session. LimitationsFor some clients, anxiety and depression levels may have alleviated without therapy. No outcome data were collected following therapy cessation. Therefore, conclusions regarding maintenance and long-term effects of therapy cannot be made. ConclusionAnxiety UK provide highly effective psychological therapies for anxiety and depression. Flexibility in the number of therapy sessions provided is recommended for NHS services and those of external organisations.

Improving Access to Psychological Therapies (IAPT) services outcomes for people with learning disabilities: national data 2012–2013 to 2019–2020

AbstractPrimary care interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. One of the priorities for IAPT services is to reduce inequalities in access and outcomes for potentially disadvantaged populations. This paper uses national data from the years 2012–2013 to 2019–2020 to present a comparison of service process and therapy outcomes for people with learning disabilities. Annual data for people with learning disabilities, people with other recorded disabilities and people with no recorded disabilities were extracted from a publicly available, national data source. Data are presented graphically with relative risk calculated for each variable and year, and show a broadly similar pattern of waiting time access for people with learning disabilities and people with no disabilities, and a broadly similar proportion of people with learning disabilities and people with no disabilities who finish treatment. However, people with learning disabilities have poorer clinical outcomes than people with no disabilities. We discuss adaptations to IAPT processes and therapy provision that may further support people with learning disabilities’ access to IAPT services.Key learning aims(1)To describe how IAPT services record disabilities, and in particular record whether a person identifies themselves as having a learning disability.1(2)To explore the differences in processes and therapy outcomes for people with learning disabilities compared with people with no disabilities and people with other disabilities.(3)To understand adaptations to IAPT processes and therapies that may make IAPT services more accessible to people with learning disabilities.

Development and application of criteria to evaluate written CBT self-help interventions adopted by Improving Access to Psychological Therapies services

Abstract Guided CBT self-help represents a low-intensity intervention to deliver evidence-based psychological therapy within the Improving Access to Psychological Therapies (IAPT) programme. Best practice guidance highlighting characteristics associated with CBT self-help is available to help services reach decisions regarding which interventions to adopt. However, at present a single process to evaluate written CBT self-help interventions informed by guidance is lacking. This study reports on the development of a standardised criteria-driven process that can be used to determine the extent written CBT self-help interventions are consistent with guidance regarding the fundamental characteristics of low-intensity CBT and high-quality written patient information. Following development, the process was piloted on 51 IAPT services, with 23 interventions identified as representing free-to-use written CBT self-help interventions. Overall, inter-rater reliability was acceptable. Following application of the criteria framework, 14 (61%) were considered suitable to be recommended for use within the IAPT programme. This pilot supports the development and potential utility of an independent criteria-driven process to appraise the suitability of written workbook-based CBT self-help interventions for use within the IAPT programme. Key learning aims (1) To recognise the range of written low-intensity CBT self-help interventions currently used within IAPT services. (2) To identify separate criteria associated with high-quality written CBT self-help interventions. (3) To use identified criteria to develop a framework to evaluate written workbook based low-intensity CBT self-help interventions for use within the IAPT programme. (4) To evaluate inter-rater reliability of the criteria framework to evaluate the quality and appropriateness of written workbook based low-intensity CBT self-help interventions used within IAPT services.

The effectiveness of remote therapy in two London IAPT services

Abstract The COVID-19 pandemic increased population levels of depression and anxiety, and infection control measures obliged services to provide psychological therapies remotely. Evidence for the routine provision of psychological therapy via telephone and video-conferencing is limited. This study compared therapy outcomes for 5360 clients in two London Improving Access to Psychological Therapy (IAPT) services before and after homeworking produced a compete shift to remotely delivered therapy. Despite the psychological impacts of pandemic restrictions, and the use of a novel therapy modality in video-conferencing, recovery rates and net score change improved in both services, significantly in one. There was no significant worsening of outcomes for any demographic group or presenting disorder. The findings suggest that for those able to access it, therapy provided by telephone and video is a clinically effective option for IAPT services. Key learning aims (1) To assess the clinical effectiveness of delivering IAPT therapies remotely. (2) To gain insight into the impacts of remote therapy on different client groups, including ethnicity, gender, age and presenting problem. (3) To assess the impact of remote therapy on access to IAPT services.

What about the therapist? – a quantitative exploration of the pathways from a therapist’s professional life to their personal well-being

AbstractOccupational stress has been identified as one of the biggest contributors to therapists’ poor mental well-being; however, these ‘wear and tear’ effects are not universal. This study aimed to distinguish between these experiences, by exploring potential avenues through which a therapist’s professional life may impact their well-being. Previous research has highlighted four avenues: self-doubt, developmental depletion, developmental growth, and years of experience. A sample of 65 cognitive behavioural therapists were recruited from four Improving Access to Psychological Therapies (IAPT) services and a cognitive behavioural therapy training course at Buckinghamshire New University. A quantitative cross-sectional survey design was employed. Each participant completed a questionnaire consisting of subscales of the ‘Development of Psychotherapist Common Core Questionnaire’ to measure potential avenues (Orlinskyet al., 1999a), and the Warwick-Edinburgh Mental Well-being Scale to measure mental well-being (Tennantet al., 2007). A multiple regression andpost-hocmediation analyses were conducted. The multiple regression analysis found three significant direct pathways predicting well-being: self-doubt, developmental depletion, and developmental growth. Thepost-hocmediation analyses found two significant indirect pathways between self-doubt and well-being mediated by developmental experience (growth and depletion). Years of experience had a non-significant direct and indirect pathway predicting well-being. The results suggested that therapists experiencing more growth, less depletion and less self-doubt experienced more positive mental well-being than those experiencing depletion and self-doubt, and less growth. When therapists experience high self-doubt, whether they also experience depletion or growth, they experience poor mental well-being. The implications for practice and future avenues of research are discussed.Key learning aims(1)To understand the potential impact of therapists’ professional lives on their well-being.(2)To understand the role of developmental experience and self-doubt.

Conflicts of Identity – How Counsellors Practice CBT 5 Years Post Qualification

Cognitive Behaviour therapy (CBT) relies on homogenous practice for it’s evidence base. However training to an accreditable standard in the UK requires 3 years of “core professional” training in addition to 1 years CBT training for IAPT (Improving Access to Psychological Therapy, trained for primary care cases only) and 2 years for more complex roles. The core professional training has unique aspects which may differ between professional groups (Nursing, Counselling, Occupational Therapy, etc) have varied ideological standpoints and practice rituals, and have the potential to conflict with aspects of CBT. This study asks the question “How do (BACP accreditable) Counsellors and psychotherapists (Hereafter counsellors) in High Intensity IAPT roles practice CBT”? and achieves this through analysis of a focus group of 5 counsellors with at least 3 years CBT experience using a thematic analysis methodology. Five themes were identified - processes in transition, ongoing processes reconciling roles, Features retained from counselling practice, Features changed from counselling practice, and features of CBT resisted and not adopted. Results suggest a broad adaptation to CBT with some aspects of counselling (Responsiveness to the client, knowing the whole of the client) emphasised more or differently to conventional views on CBT Practice. Counsellors do not adopt, or try to avoid adopting, some of the more positivist aspects of CBT, and this remains an ongoing source of conflict in the application of CBT. Implications: Counsellors do not fully conform to the CBT model of practice. Further research is necessary to establish whether this affects outcomes.

The impact of mental health support for the chronically ill on hospital utilisation: Evidence from the UK

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.

Predicting treatment outcomes in improving access to psychological therapy (IAPT) services

PurposeGiven the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to explore client- and service-related variables that predict successful treatment outcomes and clients’ dropout. Clinician-rated clients’ motivation to change was also explored as a potential predictor for both outcome variables.Design/methodology/approachA convenience sample of 1,135 (F = 752; Mage = 39.4) was collected from three IAPT services in the North West of England. The study adopts a quasi-experimental, observational design. The analysis involves the description of patients’ socio-demographic and clinical characteristics and the development of three outcome prediction models, using hierarchical logistic regression.FindingsAfter adjusting for confounders, employment status and motivation to change as rated by clinicians were predictive of both recovery and reliable improvement. The higher number of IAPT re-referrals was negatively associated with recovery and positively with dropouts. Clients who indicated low motivation to change and received low intensity treatment at their last session presented a higher likelihood to dropout.Research limitations/implicationsGiven that the evaluation of clients’ motivation to change was solely reliant on clinical judgement, as no validated measure was used, further robust research is recommended to draw sensible conclusions.Originality/valueThis is the first study evaluating clinician-rated motivation to change as a significant predictor of treatment outcomes and dropouts within the IAPT setting. Further research implications are discussed.

Establishing a service improvement network to increase access to care and improve treatment outcomes in community mental health: a series of retrospective cohort studies

BackgroundNational reports using aggregate data have demonstrated that referrals to improving access to psychological therapies (IAPT) services increase year-on-year, but some groups struggle to access the services and outcomes are variable. To identify moderators of access and outcomes, individual patient data are required to control for confounding factors and mitigate ecological biases, and a collaborative effort is needed to carry through findings to local policy and practice. We created a network of services for these purposes. MethodsAs part of the network, a dataset was formed using routinely collected anonymised data from all individual patients referred to eight IAPT services across the north, central, and east London areas, UK (total population n=483 683; mean age 37·83 years [SD 14·40]; female n=311 790 [66·25%], male n=158 860 [33·75%]; Black and minority ethnic n=137 373 [35·40%], White n=250 740 [64·60%]). Cohort studies were done using pre-treatment clinical, sociodemographic, treatment-related, and care pathway data, to investigate the effects of service-level changes to care, and identify groups for whom there are inequalities in access or poorer treatment outcomes. Primary analyses involved regression modelling and propensity score matching. NHS ethical approval was not required for this study (confirmed by the Health Research Authority July 2020, reference number 81/81). The data were provided by the IAPT services for evaluation as part of a wider service improvement project conducted in accordance with the procedures of the host institution and the NHS Trusts which operate the IAPT services (project reference 00519-IAPT). FindingsAfter adjustment for all available confounders, increases in the number of treatment sessions received per patient (odds ratio 1·09, 95% CI 1·08–1·10), reductions in non-attended sessions (0·85, 0·84–0·86), and matching treatments to diagnoses (based on National Institute for Health and Care Excellence guidelines) were associated with better odds of symptomatic remission (0·91, 0·88–0·95). Furthermore, people aged 65 years and older had better outcomes than younger patients (1·33, 1·24–1·43), but were under-represented, and people younger than 25 years not in employment, education, or training (NEETS) had worse outcomes (0·68, 0·63–0·74). Social gradients were observed: people living in the least deprived areas had considerably better outcomes than those in more deprived areas, despite similar levels of access to care and referrals (1·28, 1·07–1·53). Consequently, the services improved the system of appointment reminders to reduce non-attendance, offered training and consultations to staff on matching treatment to diagnoses, and have set up initiatives to encourage more referrals of older adults and improve access and outcomes for NEETS. InterpretationThese studies demonstrate the value in appropriate data sharing aimed specifically at service improvement. Collaboration between services can better inform potential area-level modification to treatment pathways to improve access and care for adults with depression and anxiety. FundingWellcome Trust (grant number 201292/Z/16/Z).

A Community Learning Disability Team (CLDT) and Improving Access to Psychological Therapies (IAPT) service working together to adapt, deliver and evaluate the effectiveness of a ‘Coping with My Feelings’ psychoeducational group for adults with learning disabilities or difficulties

Adults with learning disabilities (LD) experience higher rates of mental health difficulties and additional barriers to health care services compared with the general population. To address this, a CLDT and IAPT service collaborated to embed reasonable adjustments at a service level and adapted a ‘Stress and Mood Management’ group, renamed Coping with my Feelings. In this article, we will refer to this group as ‘Coping with my Feelings’. Findings are presented to encourage future collaborations.

Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records

ObjectivesSickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner...

A comparison of completion and recovery rates between first-line protocol-based cognitive behavioural therapy and non-manualized relational therapies within a UK psychological service.

This study compares completion and recovery rates between protocol-based cognitive behavioural therapy (CBT), offered as a first-line therapy for common mental health problems as per national guidelines, and relational therapies (RTs), scarcely provided in the English Improving Access to Psychological Therapies (IAPT) programme. This is a non-randomized, naturalistic study in a treatment-seeking community sample (n = 708). RTs consist of brief psychodynamic and relational integrative therapy. Completion rates relied on clinicians' coding and recovery rates were calculated based on the Patient Health Questionnaires-9 and the Generalized Anxiety Disorder-7. Doubly robust regression analysis was used to control both the treatment allocation and outcome variables for pretreatment differences between the intervention groups. Significantly more RT clients completed treatment compared with CBT clients. No significant differences in recovery rates between CBT and RTs were found using traditional null hypothesis significance tests; the groups were found to be equivalent using equivalence tests. Only when the analysis was repeated in treatment completers did CBT clients achieve around one-quarter higher recovery rates. Both CBT and RTs appeared to be equally effective and showed recovery and completion rates equivalent to or above the national average. These findings demonstrate the advantages of therapies other than CBT. Future research is needed to replicate the equivalence between these two treatments and to explore specific patient characteristics that make one treatment more suitable and acceptable than the other.