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Cited by 54Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

The acceptability, effectiveness, and durability of cognitive analytic therapy: Systematic review and meta‐analysis

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Hallam, Craig, Simmonds‐Buckley, Melanie, Kellett, Stephen, Greenhill, Beth, Jones, Andrew·2021·Psychology and Psychotherapy: Theory, Research and Practice
DOI 10.1111/papt.12286
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Abstract

Objectives: This paper sought to conduct a meta‐analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. Design: Systematic review and meta‐analysis. Methods: PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre–post/post‐follow‐up effect sizes (ESs) were extracted and synthesized in a random‐effects meta‐analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between‐group ES from trials of CAT. Results: Twenty‐five studies providing pre–post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre–post improvements in global functioning (ES = 0.86; 95% CI 0.71–1.01, N = 628), moderate‐to‐large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51–0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80–1.29, N = 586). All these effects were maintained or improved upon at follow‐up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small–moderate, significant post‐treatment benefits compared to comparators in nine clinical trials (ES = 0.36–0.53; N = 352). The average dropout rate for CAT was 16% (range 0–33%). Conclusions: Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base. Practitioner points: Large pre–post reductions in global functioning and depression outcomes and moderate–large reductions in interpersonal problems are evident after CAT. The effects of CAT appear durable, and interpersonal functioning significantly improves over follow‐up time. CAT produces small–moderate benefits compared to trial comparators. CAT appears to be an engaging psychotherapy that maintains patients in treatment.

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Sorted by citations

Authors
Hallam, C., Simmonds‐Buckley, M., Kellett, S., Greenhill, B., & Jones, A.
Affiliations
  • University of Liverpool (GB)
  • University of Sheffield (GB)
  • Sheffield Health and Social Care NHS Foundation Trust (GB)
Corresponding author
Simmonds‐Buckley, Melanie
ORCID
Venue
Psychology and Psychotherapy: Theory, Research and Practice
Publisher
Wiley
Published
2020-06-15
Volume
94
Issue
S1
Pages
8-35
ISSN
  • 1476-0835 (ISSN-L)
  • 2044-8341
DOI
10.1111/papt.12286
OpenAlex
W3035169479
Cited by
54
References
9
Citations by year
2026: 10 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 13 · 2021: 7 · 2020: 4
FWCI
0.57
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychology and Psychotherapy Theory Research and Practice (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
cognitive analytic therapy, treatment acceptability, dropout rates, treatment durability, depression, interpersonal problems, global functioning, psychotherapy effectiveness
MeSH terms
Cognition, Humans, Psychotherapy, Treatment Outcome, Outcome Assessment, Health Care

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