Source/Disclosures
Disclosures:
Barkham reports being on the editorial board of the journal published by the British Association for Counselling and Psychotherapy (BACP), for which he is entitled to an honorarium, and previously being an unpaid member of the BACP Research Committee and Scientific Committee and receiving travel expenses, as well as having been the principal investigator for grants from the Mental Health Foundation to fund the development of the CORE-OM. Please see the study for all other authors’ relevant financial disclosures.
Person-centered experiential therapy was non-inferior to cognitive behavioral therapy for treating moderate or severe depression at 6 months, according to study results published in The Lancet Psychiatry.
However, person-centered experiential therapy (PCET) may be inferior to CBT at 12 months, researchers noted. They analyzed data from the U.K. Government’s Improving Access to Psychological Therapies (IAPT) initiative in 2008, which implemented a national program of accessible psychological therapies in England.
“An early report of IAPT data, subsequent published outputs of large practice-based data collected from routine IAPT services and National Health Service (NHS) Digital reports of annual recovery rates, have consistently reported equivalent outcomes between CBT and PCET,” Michael Barkham, PhD, of the department of psychology at the University of Sheffield in the U.K., and colleagues wrote. “However, patients are not randomly assigned in such datasets, leading to the possibility of confounding by indication. Furthermore, whether all counsellors are trained in PCET and deliver high-quality treatment is unknown, hence the need for an RCT in which the delivery of PCET can be quality assured.”
In the current pragmatic, randomized, non-inferiority trial, the researchers sought to determine whether PCET was cost effective and non-inferior compared with CBT for treating moderate and severe depression within the IAPT service. They recruited individuals aged 18 years or older with moderate or severe depression according to the Clinical Interview Schedule-Revised and excluded those who presented with an organic condition, a prior diagnosis of personality disorder, bipolar disorder or schizophrenia, drug or alcohol dependency, an increased clinical risk for suicide or a long-term physical condition. They randomly assigned eligible participants to receive either PCET (n = 254; 54% women; 89% white) or CBT (n = 256; 61% women; 88% white) via a remote, web-based system, with therapy administered by appropriately trained PCET counselors and CBT therapists according to the IAPT service delivery model. Depression severity and symptomatology measured via the Patient Health Questionnaire-9 (PHQ-9) at 6 months after random assignment served as the primary outcome, with the PHQ-9 score at 12 months after random assignments as a key secondary outcome. The researchers analyzed these outcomes in the modified intention-to-treat population, which included all randomly assigned patients with complete data, and the per-protocol population, which included all participants who did not switch from their randomized treatment and received between four and 20 sessions. They analyzed safety in all randomly assigned patients.
A total of 401 enrolled participants composed the 6-month modified intention-to-treat analysis and 319 composed the 12-month modified intention-to-treat analysis. A total of 298 participants composed the 6-month per-protocol analysis. Results showed non-inferiority of PCET compared with CBT in the intention-to-treat population, with a mean PHQ-9 score of 12.74 in the PCET group and 13.25 in the CBT group, and in the per-protocol group, with a mean PHQ-9 score of 12.73 in the PCET group and 12.71 in the CBT group, at 6 months after random assignment. The researchers noted a significant adjusted between-group difference at 12 months after random assignment, for a mean PHQ-9 score of 1.73 favoring CBT, with a 95% CI that exceeded the two-point non-inferiority margin. They reported two deaths, one of which was by suicide in the PCET group and one because of chronic obstructive pulmonary disease in the CBT group. The responsible clinician determined both were unrelated to the trial. A total of three individuals in the PCET group and one in the CBT group made more than a single use of EDs for depression-related events, and three in the PCET group and three in the CBT group made a single use. The researchers noted inpatient treatment for a depression-related event among one patient in the PCET group.
“These results show that broadly similar outcomes between treatments in the short term are not a result of potential confounding factors,” Barkham and colleagues wrote. “Future attention should turn to developing and implementing the systematic follow-up of patients to provide robust evidence of the longer-term benefits of PCET and CBT within the English IAPT national program, with the aim of developing evidence-based allocation of patients to these therapy modalities.”