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Cited by 83Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies

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Pybis, Jo, Saxon, David, Hill, Andy, Barkham, Michael·2017·BMC Psychiatry
DOI 10.1186/s12888-017-1370-7PMC PMC5466727
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Abstract

BACKGROUND: Cognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned. METHOD: A secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session. RESULTS: Counselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3-10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4-12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT. CONCLUSIONS: Outcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement.

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  • The rate of reliable improvement (41%) was comparable to that of CBT in a sample of service users at 103 IAPT services that were above the clinical cutoff on the PHQ-9 at intake (47%; Pybis et al. 2017).

    “However, the rate of reliable improvement (41%) was comparable to that of CBT in a sample of service users at 103 IAPT services that were above the clinical cutoff on the PHQ-9 at intake (47%; Pybis et al. 2017).”

    From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Pybis et al. 2017

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Authors
Pybis, J., Saxon, D., Hill, A., & Barkham, M.
Affiliations
  • British Association for Counselling and Psychotherapy (GB)
  • University of Sheffield (GB)
Corresponding author
Pybis, Jo
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2017-06-09
Volume
17
Issue
1
Pages
215-215
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-017-1370-7
PMC
PMC5466727
OpenAlex
W2622910293
Cited by
83
References
31
Citations by year
2026: 5 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 14 · 2021: 9 · 2020: 8 · 2019: 14 · 2018: 11 · 2017: 2
FWCI
11.87
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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 behavioral therapy, counseling, depression, Improving Access to Psychological Therapies, treatment effectiveness, treatment efficiency, number of treatment sessions, PHQ-9, recovery rate, mental health service utilization, cost-effectiveness, UK mental health services, secondary mental health care, primary care mental health
MeSH terms
Adult, Major Depressive Disorder, Depressive Disorder, Major, Female, Genetic Counseling, United Kingdom, Humans, Male, Medical Audit, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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