The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates

Simmonds‐Buckley, Melanie; Osivwemu, Ese-Oghene; Kellett, Stephen; Taylor, Catherine

doi:10.1016/j.cpr.2022.102187

Cited by 11 publications

(6 citation statements)

References 45 publications

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“…A recent meta-synthesis suggests that a focus on the therapeutic relationship is key in therapy for self-harm, supporting the use of relational approaches like CAT [ 42 ]. A propensity score-matched case-controlled study found that 8-session CAT within NHS ‘talking therapies’ settings was associated with comparable change to CBT for depression and anxiety, but with a lower rate of attrition [ 43 ], which is consistent with other research [ 28 ] and highlights the acceptability of the approach. A recent patient preference trial in an NHS talking therapies context also identified that patients typically preferred CAT to CBT (72% vs 28%), though this is likely influenced by many participants having already experienced CBT [ 44 ].…”

Section: Introductionsupporting

confidence: 71%

“…CAT was efficacious in reducing psychological difficulties in RCTs compared with TAU ( g = 0.53), and mixed comparators ( g = 0.36). Another meta-analysis indexes the good acceptability of CAT, reporting a comparatively low dropout rate of 19% [ 28 ]. This rate was lower than for comparator treatments, and benchmarks well against other therapies, particularly since CAT has typically been evaluated in complex and hard-to-treat clinical populations.…”

Section: Introductionmentioning

confidence: 99%

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The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

Taylor,

Adeyemi,

Marlow

et al. 2024

Pilot Feasibility Stud

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Background Self-harm is a prevalent behaviour that has a major detrimental impact on a person’s life. Psychological therapies have the potential to help, but evidence of effective interventions remains limited. Access and acceptability of interventions can also be a significant challenge, with individuals either being unable to access help or having to endure long waiting lists. Cognitive analytic therapy (CAT) is a time-limited and relationally-focused psychotherapy that may provide a valuable treatment option for people who self-harm. This protocol outlines the methodology for the first feasibility randomised controlled trial (RCT) of CAT for adults that self-harm. The trial will aim to determine the feasibility, acceptability and safety of undertaking larger-scale evaluations of CAT for self-harm within an RCT context. Method An RCT design with 1:1 allocation to CAT plus treatment as usual (TAU) or TAU alone. Participants will be adult outpatients with three or more instances of self-harm in the past year (target sample of n = 60). CAT will be 8 one-to-one weekly 60-min sessions plus a follow-up session up to 8 weeks after the last session. Assessments will occur at baseline, 12 weeks and 18 weeks after randomisation. Qualitative interviews with participants will gain insights into the feasibility and acceptability of CAT. Feasibility outcomes will be judged against progression criteria. Discussion CAT may be an effective and accessible treatment option for people who self-harm, providing a more relationally orientated alternative to more behavioural therapies. The proposed feasibility RCT is an important first step in evaluating CAT as a treatment for self-harm. Trial registration The trial was pre-registered (21/10/22) on ISR CTN (ISRCTN code: ISRCTN75661422).

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Section: Introductionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

Taylor,

Adeyemi,

Marlow

et al. 2024

Pilot Feasibility Stud

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“…The preference results found that more participants chose CAT-GSH, and this preference was most likely when previous treatment episodes were CBT. There is meta-analytic evidence 24 of the differential acceptability of CAT when it has been compared with other therapies in clinical trials and from practice-based evidence (odds ratio 0.67; 95% CI 0.48-0.93) and the current study found that CAT-GSH participants attended more sessions than CBT-GSH participants. It is acknowledged that it is difficult to disentangle effect of CAT-GSH and preference on increased attendance rates, as most CAT-GSH participants expressed a treatment preference.…”

Section: Discussionmentioning

confidence: 50%

Cognitive–behavioural versus cognitive–analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial

Kellett,

Bee,

Smithies

et al. 2023

Br J Psychiatry

Self Cite

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Background Guided self-help (GSH) for anxiety is widely implemented in primary care services because of service efficiency gains, but there is also evidence of poor acceptability, low effectiveness and relapse. Aims The aim was to compare preferences for, acceptability and efficacy of cognitive–behavioural guided self-help (CBT-GSH) versus cognitive–analytic guided self-help (CAT-GSH). Method This was a pragmatic, randomised, patient preference trial (Clinical trials identifier: NCT03730532). The Beck Anxiety Inventory (BAI) was the primary outcome at 8- and 24-week follow-up. Interventions were delivered competently on the telephone via structured workbooks over 6–8 (30–35 min) sessions by trained practitioners. Results A total of 271 eligible participants were included, of whom 19 (7%) accepted being randomised and 252 (93%) chose their treatment. In the preference cohort, 181 (72%) chose CAT-GSH and 71 (28%) preferred CBT-GSH. BAI outcomes in the preference and randomised cohorts did not differ at 8 weeks (−0.80, 95% confidence interval (CI) −4.52 to 2.92) or 24 weeks (0.85, 95% CI −2.87 to 4.57). After controlling for allocation method and baseline covariates, there were no differences between CAT-GSH and CBT-GSH at 8 weeks (F(1, 263) = 0.22, P = 0.639) or at 24 weeks (F(1, 263) = 0.22, P = 0.639). Mean BAI change from baseline was a reduction of 9.28 for CAT-GSH and 9.78 for CBT-GSH at 8 weeks and 12.90 for CAT-GSH and 12.43 for CBT-GSH at 24 weeks. Conclusions Patients accessing routine primary care talking treatments prefer to choose the intervention they receive. CAT-GSH expands the treatment offer in primary care for patients with anxiety seeking a brief but analytically informed GSH solution.

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“…A pilot randomized controlled trial evaluated the feasibility, safety, helpfulness, and effectiveness of CAT for bipolar affective disorder, with the results suggesting its potential benefits (Evans et al, 2017). CAT has been described as a relatively acceptable and effective brief psychotherapy for individuals with complex psychological disorders (Simmonds-Buckley et al, 2022). Furthermore, a study sought to intensively evaluate the outcomes of CAT for bipolar affective disorder, indicating the limited evidence for its treatment and the need for further research in this area.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of Non-invasive Brain Stimulation (NIBS) in combination with Cognitive Analytic Therapy (CAT); a complex cocaine abuser case

Khodayarifard,

Kamranvand,

Rostami

2024

Preprint

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Drug addiction, a global problem affecting 275 million people, is a complex disorder characterized by compulsive substance use despite negative consequences. Neuroplasticity changes in the brain’s circuits, particularly those involving dopamine, play a crucial role in addiction. Non-invasive brain stimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation, show promise as adjunctive treatments for substance use disorders, including cocaine use disorder. Combining these brain stimulation therapies with psychological interventions may enhance treatment outcomes and reduce relapse rates. In this study, a 38-year-old Iranian woman, diagnosed with cocaine use disorder, underwent a multi-faceted neuropsychological treatment program. Her husband also received psychological treatment but not biological treatment. After treatment, both the woman and her husband were able to completely stop using cocaine for more than three years. The study used various assessments, including self-report tests and brain mapping, to evaluate the effectiveness of the interventions. The woman showed a significant reduction in symptoms and improvement in mood regulation. This study highlights the effectiveness of a multifaceted approach to treating cocaine addiction, including neurological and psychological interventions. It suggests that non-invasive brain manipulation and Cognitive Analytic Therapy (CAT) may be effective in treating complex cases. However, further research is needed to establish the efficacy of CAT for bipolar affective disorder. The study emphasizes the importance of considering biological, psychological, and social factors in the treatment of substance use disorders.

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The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates

Cited by 11 publications

References 45 publications

The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

Cognitive–behavioural versus cognitive–analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial

The effectiveness of Non-invasive Brain Stimulation (NIBS) in combination with Cognitive Analytic Therapy (CAT); a complex cocaine abuser case

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