Psychological Medicine

Original Articles

Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample

William B. Stilesa1 c1, Michael Barkhama2, John Mellor-Clarka3 and Janice Connella4

a1 Miami University, Oxford, OH, USA

a2 University of Sheffield, Sheffield, UK

a3 CORE Information Management Systems, Rugby, UK

a4 University of Leeds, Leeds, UK

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.

(Received February 14 2007)

(Revised June 25 2007)

(Accepted July 06 2007)

(Online publication September 10 2007)

Correspondence

c1 Address for correspondence: Professor W. B. Stiles, Department of Psychology, Miami University, Oxford, OH 45056, USA. (Email: stileswb@muohio.edu)

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