Acceptability and effectiveness of cognitive analytic therapy (CAT) for depression for treatment returners to NHS talking therapies: A pilot evaluation

Objectives

There is evidence that over one quarter of patients return to National Health Service (NHS) talking therapies (TT) services, and the needs of these patients are poorly understood and catered for. This project investigated the acceptability and effectiveness of delivering cognitive analytic therapy (CAT) for patients with depression returning to a TT service with childhood trauma and associated relational difficulties.

Methods

A case-controlled pilot study using TT sessional outcome measures. A 16-session CAT was offered to N = 76 patients who had previously received a high-intensity intervention (mainly cognitive-behavioural therapy; CBT) in the same TT service. Dropout rates, recovery rates and when recovery occurred during the CAT treatment episode were calculated. CAT outcomes were compared against the previous treatment episodes (n = 47) and also benchmarked against the evidence base. Patients were followed up after receiving CAT (n = 16) to assess the durability of change. The number then returning to the TT service after receiving CAT was also tracked.

Results

The dropout rate for CAT was 16.9% and the reliable recovery rate was 40%. Reliable and/or clinically significant reductions in depression tended to occur during early CAT sessions. At a group level, there were significant reductions in depression during CAT. There was no evidence of relapse at follow-up. The return rate to the service following CAT was 28.94%.

Conclusions

CAT appears useful to consider in the offer for patients returning to TT services. Clinical trials now need to focus on the treatment return patient group in TT services across the stepped care model.