Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings

William B Stiles; Michael Barkham; Elspeth Twigg; John Mellor-Clark; Mick Cooper

doi:10.1017/S0033291706007136

Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings

William B Stiles, Michael Barkham, Elspeth Twigg, John Mellor-Clark, Mick Cooper

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.

METHOD: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.

RESULTS: All six groups averaged marked improvement (pre-post effect size = 1.36). Treatment approach and degree of purity ('only' vs. '+1') each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0.5% as much as pre-post change). Distributions of change scores were largely overlapping.

CONCLUSIONS: Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

Original language	English
Pages (from-to)	555-66
Number of pages	12
Journal	Psychological Medicine
Volume	36
Issue number	4
DOIs	https://doi.org/10.1017/S0033291706007136
Publication status	Published - Apr 2006

Keywords

Adult
Cognitive Therapy
Female
Great Britain
Humans
Male
Mental Disorders
Mental Health Services
Middle Aged
Patient-Centered Care
Psychotherapy
Socioenvironmental Therapy
State Medicine
Treatment Outcome

Access to Document

10.1017/S0033291706007136

Cite this

@article{8180ec95d1534a8db3eaf9f8a592b48c,

title = "Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings",

abstract = "BACKGROUND: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.METHOD: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.RESULTS: All six groups averaged marked improvement (pre-post effect size = 1.36). Treatment approach and degree of purity ('only' vs. '+1') each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0.5% as much as pre-post change). Distributions of change scores were largely overlapping.CONCLUSIONS: Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.",

keywords = "Adult, Cognitive Therapy, Female, Great Britain, Humans, Male, Mental Disorders, Mental Health Services, Middle Aged, Patient-Centered Care, Psychotherapy, Socioenvironmental Therapy, State Medicine, Treatment Outcome",

author = "Stiles, {William B} and Michael Barkham and Elspeth Twigg and John Mellor-Clark and Mick Cooper",

year = "2006",

month = apr,

doi = "10.1017/S0033291706007136",

language = "English",

volume = "36",

pages = "555--66",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

number = "4",

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TY - JOUR

T1 - Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings

AU - Stiles, William B

AU - Barkham, Michael

AU - Twigg, Elspeth

AU - Mellor-Clark, John

AU - Cooper, Mick

PY - 2006/4

Y1 - 2006/4

N2 - BACKGROUND: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.METHOD: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.RESULTS: All six groups averaged marked improvement (pre-post effect size = 1.36). Treatment approach and degree of purity ('only' vs. '+1') each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0.5% as much as pre-post change). Distributions of change scores were largely overlapping.CONCLUSIONS: Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

AB - BACKGROUND: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.METHOD: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.RESULTS: All six groups averaged marked improvement (pre-post effect size = 1.36). Treatment approach and degree of purity ('only' vs. '+1') each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0.5% as much as pre-post change). Distributions of change scores were largely overlapping.CONCLUSIONS: Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

KW - Adult

KW - Cognitive Therapy

KW - Female

KW - Great Britain

KW - Humans

KW - Male

KW - Mental Disorders

KW - Mental Health Services

KW - Middle Aged

KW - Patient-Centered Care

KW - Psychotherapy

KW - Socioenvironmental Therapy

KW - State Medicine

KW - Treatment Outcome

U2 - 10.1017/S0033291706007136

DO - 10.1017/S0033291706007136

M3 - Article

C2 - 16476185

SN - 0033-2917

VL - 36

SP - 555

EP - 566

JO - Psychological Medicine

JF - Psychological Medicine

IS - 4

ER -