Psychological Medicine



Original Article

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


WILLIAM B. STILES a1c1, MICHAEL BARKHAM a2, ELSPETH TWIGG a2, JOHN MELLOR-CLARK a3 and MICK COOPER a4
a1 Miami University, Oxford, USA
a2 University of Leeds, UK
a3 CORE Information Management Systems, Rugby, UK
a4 University of Strathclyde, UK

Article author query
stiles wb   [PubMed][Google Scholar] 
barkham m   [PubMed][Google Scholar] 
twigg e   [PubMed][Google Scholar] 
mellor-clark j   [PubMed][Google Scholar] 
cooper m   [PubMed][Google Scholar] 

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.

(Published Online February 14 2006)


Correspondence:
c1 Department of Psychology, Miami University, Oxford, OH 45056, USA. (Email: stileswb@muohio.edu)


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