Depression counseling, a form of person-centered experiential therapy (PCET), is comparable to cognitive behavioral therapy (CBT) at 6 months, according to a recent UK study. Currently, PCET in the UK is considered a second-line treatment (these guidelines are currently under review). However, previous studies have shown equivalent outcomes between CBT and PCET. Given the need to increase access to depression treatment, the researchers conducted a pragmatic, randomized, non-inferiority trial to compare the 2 modalities.
The researchers recruited participants age 18 and older. Patients were included if they scored 12 or higher on the Patient Health Questionnaire-9 (PHQ-9) assessment and expressed no preference for either treatment type. Patients with an organic condition, a previous personality disorder diagnosis, bipolar disorder, schizophrenia, or a long-term physical condition were excluded. Patients with alcohol or substance dependency or suicide risk were also excluded.
Participants were randomly assigned to either CBT or PCET treatment groups. Participants submitted self-reported assessments at 6 and 12 months.
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The baseline PHQ-9 scores for the 401 participants who completed a PHQ-9 assessment at 6 months were 18.82 (SD 4.15) for the PCET group and 19.14 (4.05) for the CBT group. At 6 months, the mean PHQ-9 score was 12.74 (SD 6.54) in the PCET group and 13.25 (6.35) in the CBT group. The mean change in the PCET group was 6.08 points (SD 6.12) and the mean change in the CBT group was 5.89 points (6.60).
Limitations include that supervision was less frequent during the trial than the standard of care.
“At 12 months, the modified intention-to-treat analysis showed a significant adjusted between-group difference in PHQ-9 score in favor of CBT, with a 95% CI exceeding the 2-point non-inferiority margin,” the study authors reported.
“The results from our primary analysis support the non-inferiority of PCET to CBT in the short term,” the researchers concluded. “However, the results are qualified by the additional improvements at 12 months in participants presenting with severe depression who received more than a minimal dose of CBT in the per-protocol population. Taking a balanced view, in light of the increasing high demand for psychological services and the importance of patient choice, a focus on the appropriate levels of investment in the delivery of PCET within the national IAPT programme is needed.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Barkham M, Saxon D, Hardy GE, et al. Person-centered experiential therapy versus cognitive behavioural therapy delivered in the English Improving Access to Psychological Therapies service for the treatment of moderate or severe depression (PRaCTICED): a pragmatic, randomised, non-inferiority trial. Lancet Psychiatry. Published online June 1, 2021. doi:10.1016/S2215-0366(21)00083-3