REFLECT - RandomisEd FeasibiLity Evaluation of Cognitive Therapies
Professor Tom Burns (core Principle Investigator), Professor Glenys Parry, Ksenija Yeeles (Trial Manager), Professor John Geddes, Eva Burns-Lundgren, Yvonne Taylor and Catriona Anderson (Research Assistant)
Although improving access to psychological therapies is a top national mental health priority, psychological therapies remain restricted within the NHS. Cognitive Behavioural Therapy (CBT) is the most frequently used psychotherapy in the NHS and also has the largest evidence base (Roth and Fonagy, 2005). However, only 50% of patients respond to CBT and drop-outs are frequent (Churchill et. al., 2001), resulting in many clients requiring an alternative therapy. Alternative short-term therapies to CBT are endorsed by NICE, recognising their value and also acknowledging that CBT is not suitable for all patients.
Cognitive Analytic Therapy (CAT) (Ryle and Kerr, 2008) is a short-term therapy which shares with CBT an emphasis on structured methods, using exercises and ‘homework’, however, its emphasis is on relationships and the impact of early experience in creating patterns of coping that are ineffective or harmful. The evidence base for the effectiveness of CAT is limited but has grown in recent years. This study aims to see if a large randomised controlled trial could be conducted with CBT and CAT to improve the evidence base for this therapy.
1. Can CBT and CAT therapists work together to identify patients whom they consider can be effectively treated by either approach, and thus be randomly allocated to either CAT or CBT?
2. Will patients consent to the randomisation and cooperate with research interviews?
3. Can the treatments be conducted within a research framework, including structured follow-up?
4. What would be the requirements for an effective trial delivery infrastructure?
A secondary, though important, aim is to introduce a research culture into a non-CBT psychotherapy setting. We would build on this to establish a trial platform for a future, more definitive, explanatory head-to-head trial of CAT and CBT to establish relative efficacy and indications.
We are conducting a pilot (feasibility) study of CAT against CBT, involving forty participants with a primary diagnosis of anxiety, depression or both. There are also 12 CBT and CAT therapists from Oxford Health NHS Foundation Trust committed to this research. The study is expected to run for 30 months, with three months to set up, twelve months for recruitment, six months for intervention and another for follow up.
Clients are referred to the study during their initial psychotherapy assessment if their therapist believes they meet the following eligibility criteria:
Diagnosis of Anxiety, Depression or both
- 18 years or over (adult and older adult)
- Assessed as being suitable for short term psychotherapy
- Equally suited to CAT and CBT in the assessor’s opinion and therefore could be randomly allocated to one or the other therapy.
Those who consent to the take part in the study are interviewed after their initial psychotherapy assessment, shortly before their therapy, after their therapy is complete and six months later. The interview consists of several interviewer rated and self-rated symptom measures and participants are given £25 for their time.
- Number of patients randomised.
- Proportion of patients considered suitable for the trial who consented.
- Number of therapy sessions attended.
- Number of completed research interviews.
- Mean total and sub-scale scores on the self-rated and interviewer rated instruments
For more information please contact Ksenija Yeeles at firstname.lastname@example.org