Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence
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Objectives: Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design: A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods: A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions: Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points: IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development.
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The effect size for mean changes in anxiety from baseline to final for both Pragmatic and Value-based algorithm groups were larger than those seen in a meta-analysis of outcomes from a real-world evidence-based treatment program for anxiety (1.13 and 1.08 for this article; 0.88 from the meta-analysis).
“The effect size for mean changes in anxiety from baseline to final for both Pragmatic and Value-based algorithm groups were larger than those seen in a meta-analysis of outcomes from a real-world evidence-based treatment program for anxiety (1.13 and 1.08 for this article; 0.88 from the meta-analysis).50”
From Using Machine Learning to Match Clients and Therapy Providers: Evaluating Clinical Quality and Cost of Care (2025) · cites this paper as [50]
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Self-citationThe rise of artificial intelligence for cognitive behavioral therapy: A bibliometric overview
Vanhée, L., Andersson, G., Garcia, D., & Sikström, S. (2025) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70033 · Cited by 14 · see citing works
Bernard, K., Wildman, J. M., Tanner, L. M., Stoniute, A., Still, M., Green, R., Eastaugh, C., Sowden, S., & Thomson, K. H. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075237 · Cited by 12 · see citing works
Roberts, K., Travers-Hill, E., Coker, S., Troup, J., Casey, S., Parkin, K., & Kim, Y. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000258 · Cited by 11 · see citing works
Simon, N., Cunningham, E., Samuel, V., & Waters, C. (2024) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2023.2180143 · Cited by 8 · see citing works
Lee, J. L., Billovits, C., Chen, S.-Y., Wickham, R. E., Kocher, B., Chen, C. E., & Lungu, A. (2025) · Value in Health · doi:10.1016/j.jval.2025.06.002 · Cited by 8 · see citing works
Landry, C. A., McCall, H. C., Beahm, J. D., Titov, N., Dear, B., Carleton, R. N., & Hadjistavropoulos, H. D. (2024) · JMIR Formative Research · doi:10.2196/54132 · Cited by 6 · see citing works
“Completer analysis was used (ie, we did not impute missing data), as is common in pilot studies [55].”
MethodYoshinaga, N., Thew, G. R., Hayashi, Y., Matsuoka, J., Tanoue, H., Takanashi, R., Araki, M., Kanai, Y., Smith, A., Grant, S. H. L., et al. (2023) · JMIR Formative Research · doi:10.2196/45136 · Cited by 6 · see citing works
Bradley, D. F., Ching, T. H. W., Languido, L., & Brady, R. E. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.11.006 · Cited by 2 · see citing works
Atik, E., Stricker, J., Schückes, M., & Pittig, A. (2022) · doi:10.2196/preprints.44742 · Cited by 23 · see citing works
- Authors
- Wakefield, S., Kellett, S., Simmonds‐Buckley, M., Stockton, D., Bradbury, A., & Delgadillo, J.
- Affiliations
- University of Sheffield (GB)
- Sheffield Health and Social Care NHS Foundation Trust (GB)
- Mid Yorkshire Hospitals NHS Trust (GB)
- Corresponding author
- Kellett, Stephen
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2020-06-23
- Volume
- 60
- Issue
- 1
- Pages
- 1-37
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W3038066391
- Cited by
- 222
- References
- 92
- Citations by year
- 2026: 42 · 2025: 47 · 2024: 39 · 2023: 35 · 2022: 38 · 2021: 19 · 2020: 2
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Clinical Psychology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- Improving Access to Psychological Therapies, psychotherapy, depression, anxiety, dissemination of evidence-based treatment, access to mental health care, treatment effect size, functional disability, follow-up support, relapse prevention, dropout
- MeSH terms
- United Kingdom, Humans, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome
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