Skip to main content
×
×
Home

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)
References
Hide All
Barkham, M, Connell, J, Stiles, WB, Miles, JNV, Margison, F, Evans, C, Mellor-Clark, J (2006). Dose-effect relations and responsive regulation of treatment duration: the good enough level. Journal of Consulting and Clinical Psychology 74, 160167.
Barkham, M, Evans, C, Margison, F, McGrath, G, Mellor-Clark, J, Milne, D, Connell, J (1998). The rationale for developing and implementing core outcome batteries for routine use in service settings and psychotherapy outcome research. Journal of Mental Health 7, 3547.
Barkham, M, Gilbert, N, Connell, J, Marshall, C, Twigg, E (2005). Suitability and utility of the CORE-OM and CORE-A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings. British Journal of Psychiatry 186, 239246.
Barkham, M, Margison, F, Leach, C, Lucock, M, Mellor-Clark, J, Evans, C, Benson, L, Connell, J, Audin, K, McGrath, G (2001). Service profiling and outcomes benchmarking using the CORE-OM: towards practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology 69, 184196.
Barkham, M, Mullin, T, Leach, C, Stiles, WB, Lucock, M (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.
Barkham, M, Rees, A, Shapiro, DA, Stiles, WB, Agnew, RM, Halstead, J, Culverwell, A, Harrington, VMG (1996). Outcomes of time-limited psychotherapy in applied settings: replicating the Second Sheffield Psychotherapy Project. Journal of Consulting and Clinical Psychology 64, 10791085.
Beutler, LE (1991). Have all won and must all have prizes? Revisiting Luborsky et al.'s verdict. Journal of Consulting and Clinical Psychology 59, 226232.
Butler, AC, Chapman, JE, Forman, EM, Beck, AT (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review 26, 1731.
Cahill, J, Barkham, M, Stiles, WB, Twigg, E, Hardy, GE, Rees, A, Evans, C (2006). Convergent validity of the CORE Measures with measures of depression for clients in cognitive therapy for depression. Journal of Counseling Psychology 53, 253259.
Carroll, L (1946). Alice's Adventures in Wonderland. Random House: New York. (Original work published 1865.)
Chambless, DL, Baker, MJ, Baucom, DH, Beutler, LE, Calhoun, KS, Crits-Christoph, P, Daiuto, A, DeRubeis, R, Detweiler, J, Haaga, DAF, Johnson, SB, McCurry, S, Mueser, KT, Pope, KS, Sanderson, WC, Shoham, V, Stickle, T, Williams, DA, Woody, SR (1998). Update on empirically validated therapies, II. The Clinical Psychologist 51, 316.
Chambless, DL, Hollon, SD (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66, 718.
Clark, DM, Salkovskis, PM, Hackmann, A, Wells, A, Ludgate, J, Gelder, M (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology 67, 583589.
Connell, J, Barkham, M, Stiles, WB, Twigg, E, Singleton, N, Evans, O, Miles, JNV (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.
Corney, R, Simpson, S (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.
Dobson, K (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology 57, 414420.
Ehlers, A, Clark, DM, Hackmann, A, McManus, F, Fennell, M (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy 43, 413431.
Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, Glass, DR, Pilkonis, PA, Leber, WR, Docherty, JP, Fiester, SJ, Parloff, MB (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry 46, 971982.
Elliott, R, Greenberg, LS, Lietaer, G (2004). Research on experiential psychotherapies. In Bergin and Garfield's Handbook of Psychotherapy and Behavior Change, 5th edn (ed. Lambert, M. J.), pp. 493539. Wiley: New York.
Evans, C, Connell, J, Barkham, M, Margison, F, Mellor-Clark, J, McGrath, G, Audin, K (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. British Journal of Psychiatry 180, 5160.
Evans, C, Mellor-Clark, J, Margison, F, Barkham, M, Audin, K, Connell, J, McGrath, G (2000). CORE: Clinical outcomes in routine evaluation. Journal of Mental Health 9, 247255.
Evans, R, Mellor-Clark, J, Barkham, M, Mothersole, G (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.
Feltham, C, Horton, IE (eds) (2006). Handbook of Counselling and Psychotherapy, 2nd edn. Sage: London.
Gabbard, GO, Beck, JS, Holmes, J (eds) (2005). Oxford Textbook of Psychotherapy. Oxford University Press: Oxford, UK.
Gilbert, N, Barkham, M, Richards, A, Cameron, I (2005). The effectiveness of a primary care mental health service delivering brief psychological interventions: a benchmarking study using the CORE System. Primary Care Mental Health 3, 241251.
Goldman, RN, Greenberg, LS, Angus, L (2006). The effects of adding emotion-focused interventions to the therapeutic relationship in the treatment of depression. Psychotherapy Research 16, 537549.
Greasley, P, Small, N (2005). Evaluating a primary care counseling service: outcomes and issues. Primary Care Research and Development 6, 124136.
Greenberg, LS, Watson, JC (1998). Experiential therapy of depression: differential effects of client-centered relationship conditions and process experiential interventions. Psychotherapy-Research 8, 210224.
Hannan, C, Lambert, MJ, Harmon, C, Nielsen, SL, Smart, DW, Shimokawa, K, Sutton, SW (2005). A lab test and algorithms for identifying clients at risk for treatment failure. Journal of Clinical Psychology 61, 155163.
Hardy, GE, Stiles, WB, Barkham, M, Startup, M (1998). Therapist responsiveness to client interpersonal styles during time-limited treatments for depression. Journal of Consulting and Clinical Psychology 66, 304312.
Hollon, SD, Beck, AT (2004). Cognitive and cognitive behavioral therapies. In Garfield and Bergin's Handbook of Psychotherapy and Behavior Change, 5th edn (ed. Lambert, M. J.), pp. 447492. Wiley: New York.
Hollon, SD, Thase, ME, Markowitz, JC (2002). Treatment and prevention of depression. Psychological Science in the Public Interest 3, 3977.
Holmes, J (2002). All you need is cognitive-behaviour therapy? British Medical Journal 324, 288290.
Hunot, V, Churchill, R, Silva de Lima, M, Teixeira, V (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews. Art. No.: CD001848. doi: 10.1002/14651858.CD001848.pub4.
Hunsley, J, Aubry, TD, Verstervelt, CM, Vito, D (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy 36, 380388.
Hunsley, J, Di Giulio, G (2002). Dodo Bird, Phoenix, or Urban Legend? The question of psychotherapy equivalence. Scientific Review of Mental Health Practice 1, 1122.
Hunsley, J, Lee, CM (2007). Research-informed benchmarks for psychological treatments: efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice 38, 2133.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Ladouceur, R, Dugas, MJ, Freeston, MH, Leger, E, Gagnon, F, Thibodeau, N (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.
Layard, R (2006). The case for psychological treatment centres. British Medical Journal 332, 10301032.
Leach, C, Lucock, M, Barkham, M, Noble, R, Clarke, L, Iveson, S (2005). Assessing risk and emotional disturbance using the CORE-OM & HoNOS outcome measures. Psychiatric Bulletin 29, 419422.
Leach, C, Lucock, M, Barkham, M, Stiles, WB, Noble, R, Iveson, S (2006). Transforming between Beck Depression Inventory and CORE-OM scores in routine clinical practice. British Journal of Clinical Psychology 45, 153166.
Leichsenring, F (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review 21, 401419.
Leichsenring, F, Leibing, E (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.
Leichsenring, F, Rabung, S, Leibing, E (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of General Psychiatry 6, 12081216.
Luborsky, L, Diguer, L, Seligman, DA, Rosenthal, R, Krause, ED, Johnson, S, Halperin, G, Bishop, M, Berman, JS, Schweizer, E (1999). The researcher's own therapy allegiances: a ‘wild card’ in comparisons of treatment efficacy. Clinical Psychology: Science and Practice 6, 95106.
Luborsky, L, Singer, B, Luborsky, L (1975). Comparative studies of psychotherapies: is it true that ‘Everyone has won and all must have prizes’? Archives of General Psychiatry 32, 9951008.
Lutz, W, Leon, SC, Martinovich, Z, Lyons, JS, Stiles, WB (2007). Therapist effects and therapist performance clusters in outpatient psychotherapy. Journal of Counseling Psychology 54, 3239.
Ma, SH, Teasdale, JD (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology 72, 3140.
Mellor-Clark, J, Barkham, M (2006) Quality evaluation: methods, measures and meaning. In Handbook of Counselling and Psychotherapy, 2nd edn (ed. Feltham, C. and Horton, I.), pp. 207224. Sage Publications: London.
Mellor-Clark, J, Barkham, M, Connell, J, Evans, C (1999). Practice-based evidence and standardized evaluation: informing the design of the CORE system. European Journal of Psychotherapy, Counselling and Health 2, 357374.
Mellor-Clark, J, Curtis Jenkins, A, Evans, R, Mothersole, G, McInnes, B (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.
NICE (2004 a). Anxiety: Management of anxiety (panic disorder with our without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care (Clinical guideline 23). National Institute for Clinical Excellence: London.
NICE (2004 b). Depression: Management of depression in primary and secondary care (Clinical guideline 22). National Institute for Clinical Excellence: London.
NICE (2005). Post-traumatic stress disorder (PTSD): the management of PTSD in adults and children in primary and secondary care (Clinical guideline 26). National Institute for Clinical Excellence: London.
Norcross, JC (1995). Dispelling the Dodo bird verdict and the exclusivity myth in psychotherapy. Psychotherapy 32, 500504.
Norcross, JC (ed.) (2002). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patient Needs. Oxford University Press: New York.
Roth, A, Fonagy, P (2004). What Works For Whom? A Critical Review of Psychotherapy Research, 2nd edn. Guilford Publications: New York.
Rosenzweig, S (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry 6, 412415.
Seligman, M (1995). The effectiveness of psychotherapy. American Psychologist 50, 965974.
Shadish, WR, Navarro, AM, Matt, GE, Phillips, G (2000). The effects of psychological therapies under clinically representative conditions: a meta-analysis. Psychological Bulletin 126, 512529.
Shapiro, DA, Barkham, M, Rees, A, Hardy, GE, Reynolds, S, Startup, M (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.
Stiles, WB (1983). Normality, diversity, and psychotherapy. Psychotherapy: Theory, Research, and Practice 20, 183189.
Stiles, WB, Barkham, M, Twigg, E, Mellor-Clark, J, Cooper, M (2006). Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies as practiced in UK National Health Service settings. Psychological Medicine 36, 555566.
Stiles, WB, Honos-Webb, L, Surko, M (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice 5, 439458.
Stiles, WB, Leach, C, Barkham, M, Lucock, M, Iveson, S, Shapiro, DA, Iveson, M, Hardy, G (2003). Early sudden gains in psychotherapy under routine clinic conditions: practice-based evidence. Journal of Consulting and Clinical Psychology 71, 1421.
Stiles, WB, Shapiro, DA, Elliott, R (1986). ‘Are all psychotherapies equivalent?’ American Psychologist 41, 165180.
Stirman, SW, DeRubeis, RJ, Crits-Christoph, P, Brody, PE (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.
Street, L, Niederehe, G, Lebowitz, B (2000). Toward greater public health relevance for psychotherapeutic intervention research: an NIMH workshop report. Clinical Psychology: Science and Practice 7, 127137.
Teasdale, JD, Segal, ZV, Williams, JM, Ridgeway, VA, Soulsby, JM, Lau, MA (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 68, 615623.
Wampold, BE (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Lawrence Erlbaum Associates: Mahwah, NJ.
Ward, E, King, M, Lloyd, M, Bower, P, Sibbald, B, Farrelly, S, Gabbay, M, Tarrier, N, Addington-Hall, J (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.
Westbrook, D, Kirk, J (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.
Whittal, ML, Thordarson, DS, McLean, PD (2005). Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behavior Research and Therapy 43, 15591576.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 205
Total number of PDF views: 1507 *
Loading metrics...

Abstract views

Total abstract views: 8319 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th June 2018. This data will be updated every 24 hours.