The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies

Abstract

BackgroundCognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned.MethodA secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session.ResultsCounselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3–10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4–12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT.ConclusionsOutcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1370-7) contains supplementary material, which is available to authorized users.

Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK

“…Therefore, referring clients as a first line of treatment to therapies other than CBT should be considered, as research demonstrates they are as effective as CBT (e.g. Pybis, Saxon, Hill, & Barkham ).…”

Targeted prescription of cognitive–behavioral therapy versus person-centered counseling for depression using a machine learning approach.

“…Practice-based studies comparing the effectiveness of psychological interventions reach similar conclusions. For example, a recent large-scale comparison of cognitive behavioural therapy (CBT) and person-centred counselling for depression (CfD) in primary care suggested that these treatments are equally effective (Pybis, Saxon, Hill, & Barkham, 2017).…”

Counsellors in the National Health Service: A mixed‐method study of efficacy and satisfaction from the counsellor perspective

“…National Health Service services are locally commissioned and can vary. Recent research suggests that NHS site factors do have a significant impact on client outcomes, with some services markedly less effective than others, even after controlling for patient variables, therapy type and sessions attended (Pybis et al., ). The results of this study potentially suggest some of the factors that may explain the variable effectiveness of NHS psychological therapy services.…”