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Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample

  • William B. Stiles (a1), Michael Barkham (a2), John Mellor-Clark (a3) and Janice Connell (a4)
Abstract
Background

Psychotherapy's equivalence paradox is that treatments tend to have equivalently positive outcomes despite non-equivalent theories and techniques. We replicated an earlier comparison of treatment approaches in a sample four times larger and restricted to primary-care mental health.

Method

Patients (n=5613) who received cognitive–behavioural therapy (CBT), person-centred therapy (PCT) or psychodynamic therapy (PDT) at one of 32 NHS primary-care services during a 3-year period (2002–2005) completed the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) at the beginning and end of treatment. Therapists indicated which approaches were used on an End of Therapy form. We compared outcomes of groups treated with CBT (n=1045), PCT (n=1709), or PDT (n=261) only or with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1 (n=1035), PCT+1 (n=1033), or PDT+1 (n=530), respectively.

Results

All six groups began treatment with equivalent CORE-OM scores, and all averaged marked improvement (overall pre/post effect size=1.39). Neither treatment approach nor degree of purity (‘only’ v. ‘+1’) had a statistically significant effect. Distributions of change scores were all similar.

Conclusions

Replicating the earlier results, the theoretically different approaches tended to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, incomplete data, and other issues. Insofar as these routine treatments appear effective for patients who complete them, those who fail to complete (or to begin) treatment deserve attention by researchers and policymakers.

Copyright
Corresponding author
*Address for correspondence: Professor W. B. Stiles, Department of Psychology, Miami University, Oxford, OH 45056, USA. (Email: stileswb@muohio.edu)
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M Barkham , T Mullin , C Leach , WB Stiles , M Lucock (2007). Stability of the CORE-OM and BDI-I prior to therapy: evidence from routine practice. Psychology and Psychotherapy: Theory, Research and Practice 80, 269278.

M Barkham , A Rees , DA Shapiro , WB Stiles , RM Agnew , J Halstead , A Culverwell , VMG Harrington (1996). Outcomes of time-limited psychotherapy in applied settings: replicating the Second Sheffield Psychotherapy Project. Journal of Consulting and Clinical Psychology 64, 10791085.

LE Beutler (1991). Have all won and must all have prizes? Revisiting Luborsky et al.'s verdict. Journal of Consulting and Clinical Psychology 59, 226232.

DL Chambless , SD Hollon (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66, 718.

DM Clark , PM Salkovskis , A Hackmann , A Wells , J Ludgate , M Gelder (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology 67, 583589.

J Connell , M Barkham , WB Stiles , E Twigg , N Singleton , O Evans , JNV Miles (2007). Distribution of CORE-OM scores in a general population, clinical cut-off points, and comparison with the CIS-R. British Journal of Psychiatry 190, 6974.

R Corney , S Simpson (2005). Thirty-six month outcome data from a trial of counselling with chronically depressed patients in a general practice setting. Psychology and Psychotherapy: Theory, Research and Practice 78, 127138.

I Elkin , MT Shea , JT Watkins , SD Imber , SM Sotsky , JF Collins , DR Glass , PA Pilkonis , WR Leber , JP Docherty , SJ Fiester , MB Parloff (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry 46, 971982.

C Evans , J Connell , M Barkham , F Margison , J Mellor-Clark , G McGrath , K Audin (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. British Journal of Psychiatry 180, 5160.

R Evans , J Mellor-Clark , M Barkham , G Mothersole (2006). Developing the resources and management support for routine evaluation in counselling and psychological therapy service provision: reflections on a decade of CORE development. European Journal of Psychotherapy and Counselling 8, 141161.

SD Hollon , ME Thase , JC Markowitz (2002). Treatment and prevention of depression. Psychological Science in the Public Interest 3, 3977.

J Holmes (2002). All you need is cognitive-behaviour therapy? British Medical Journal 324, 288290.

V Hunot , R Churchill , M Silva de Lima , V Teixeira (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews. Art. No.: CD001848. doi: 10.1002/14651858.CD001848.pub4.

J Hunsley , TD Aubry , CM Verstervelt , D Vito (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy 36, 380388.

R Ladouceur , MJ Dugas , MH Freeston , E Leger , F Gagnon , N Thibodeau (2000). Efficacy of a cognitive-behavioural treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology 68, 957964.

C Leach , M Lucock , M Barkham , R Noble , L Clarke , S Iveson (2005). Assessing risk and emotional disturbance using the CORE-OM & HoNOS outcome measures. Psychiatric Bulletin 29, 419422.

C Leach , M Lucock , M Barkham , WB Stiles , R Noble , S Iveson (2006). Transforming between Beck Depression Inventory and CORE-OM scores in routine clinical practice. British Journal of Clinical Psychology 45, 153166.

F Leichsenring (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review 21, 401419.

F Leichsenring , E Leibing (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. American Journal of Psychiatry 160, 12231232.

W Lutz , SC Leon , Z Martinovich , JS Lyons , WB Stiles (2007). Therapist effects and therapist performance clusters in outpatient psychotherapy. Journal of Counseling Psychology 54, 3239.

SH Ma , JD Teasdale (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology 72, 3140.

J Mellor-Clark , M Barkham , J Connell , C Evans (1999). Practice-based evidence and standardized evaluation: informing the design of the CORE system. European Journal of Psychotherapy, Counselling and Health 2, 357374.

J Mellor-Clark , A Curtis Jenkins , R Evans , G Mothersole , B McInnes (2006). Resourcing a CORE network to develop a National Research Database to help enhance psychological therapy and counselling service provision. Counselling and Psychotherapy Research 6, 1622.

S Rosenzweig (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry 6, 412415.

M Seligman (1995). The effectiveness of psychotherapy. American Psychologist 50, 965974.

WR Shadish , AM Navarro , GE Matt , G Phillips (2000). The effects of psychological therapies under clinically representative conditions: a meta-analysis. Psychological Bulletin 126, 512529.

DA Shapiro , M Barkham , A Rees , GE Hardy , S Reynolds , M Startup (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioural and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology 62, 522534.

WB Stiles (1983). Normality, diversity, and psychotherapy. Psychotherapy: Theory, Research, and Practice 20, 183189.

WB Stiles , DA Shapiro , R Elliott (1986). ‘Are all psychotherapies equivalent?’ American Psychologist 41, 165180.

SW Stirman , RJ DeRubeis , P Crits-Christoph , PE Brody (2003). Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings. Journal of Consulting and Clinical Psychology 71, 963972.

E Ward , M King , M Lloyd , P Bower , B Sibbald , S Farrelly , M Gabbay , N Tarrier , J Addington-Hall (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness. British Medical Journal 321, 13831388.

D Westbrook , J Kirk (2005). The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy 43, 12431261.

ML Whittal , DS Thordarson , PD McLean (2005). Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behavior Research and Therapy 43, 15591576.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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