Person-centred experiential therapy versus cognitive behavioural therapy delivered in the English Improving Access to Psychological Therapies service for the treatment of moderate or severe depression (PRaCTICED): a pragmatic, randomised, non-inferiority trial

Abstract

BackgroundThe UK government's implementation in 2008 of The Improving Access to Psychological Therapies (IAPT) initiative in England provided a huge increase in the availability of cognitive-behavioural therapy (CBT) for the treatment of depression and anxiety in primary care. Counselling for Depression (CfD) -a form of person-centred experiential therapy (PCET) -has since been included as an IAPT-approved therapy but there is no evidence from randomised controlled trials determining its efficacy as required by the National Institute for Clinical and Social Excellence (NICE). Given the high demand for psychological therapies, there is a need for evidence of efficacy to ensure maximum practitioner resources are available to meet this need and to offer patients choice. We aimed to determine the clinical efficacy and cost-effectiveness of PCET compared with CBT in the treatment of moderate and severe depression within the English IAPT delivery service model. MethodsWe conducted a pragmatic, non-inferiority randomised controlled trial of PCET vs. CBT for patients ≥18 years of age who met criteria for either moderate or severe depression as determined by the Clinical Interview Schedule-Revised version. We excluded participants presenting with an organic condition, psychosis, drug or alcohol dependence, or elevated clinical risk. Randomisation was carried out independent of the research team. Ethical approval was granted by the Health Research Authority (REC: 14/YH/0001). The trial registration ID is ISRCTN06461651 and the research protocol has been published. 510 patients were randomised (1:1) to PCET or CBT and were seen by appropriately trained

A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial.

“…This also has implications for the planning of the definitive noninferiority trial. A recent U.K. study conducted in a similar public health setting realized posttherapy assessment at the 24-calendar week time point (Barkham et al, 2021).…”

A longitudinal analysis of person‐centred therapy with suicidal clients

“…The current provision of PCE-CfD within the NHS is meant to be for 20 sessions (Murphy, 2019). This approach has been evidenced in a randomised controlled trial (Barkham et al, 2021).…”

Service support, work engagement and psychological wellbeing: validating an index of resource and infrastructure support for the delivery of CBT

“…Pragmatic trials have explored the efficacy of CBT as delivered in routine services (e.g. Barkham et al, 2021;Bisson et al, submitted for publication), generally identifying lower efficacy of CBT than research trials. One plausible hypothesis for this reduced efficacy of CBT in the real world is reduced availability of resoures and infrastructure support for CBT.…”

“…One plausible hypothesis for this reduced efficacy of CBT in the real world is reduced availability of resoures and infrastructure support for CBT. It is notable, for example, that pragmatic trials have offered additional training and supervision to participating therapists in order to demonstrate acceptable fidelity to the evidence-basd model (Barkham et al, 2021;Bisson et al, submitted for publication;Ehlers et al, 2013).…”