Results from the largest randomised controlled trial to date of Person-Centred Experiential Therapy (PCET) – also known as Counselling for Depression (CfD) and Person-Centred Experiential Counselling for Depression (PCE-CfD) – found no evidence of any meaningful differences between it and cognitive behavioural therapy as delivered in Improving Access to Psychological Therapies (IAPT) services provided by the NHS in England when tested at either six months after entering the trial or at the end of treatment.
The trial, led by a research group at the University of Sheffield and funded by BACP, has been published in The Lancet Psychiatry.
The results of the randomised control trial – known as PRaCTICED – further strengthen the evidence base for the effectiveness of counselling as we continue to lobby the National Institute for Health and Care Excellence (NICE) to recommend a wider choice of talking therapies for mental health conditions. It also gives stronger evidence for NICE to recommend PCET, as a frontline intervention on the same basis as CBT, for patients accessing IAPT services in England; in turn increasing the number of opportunities for counsellors to work within the NHS delivering these services.
The research findings will also help us to demonstrate to NHS England, Health Education England and service commissioners that counselling needs to play a greater role in their choice of interventions and that counsellors and psychotherapists, so often undervalued and underutilised within the NHS workforce, should play a much greater role including helping the NHS in meeting workforce expansion targets.
BACP’s Head of Research, Dr Clare Symons said: “The outcomes from the PRaCTICED trial confirm what we know from existing research using routine IAPT data. This study is particularly significant as it provides the kind of evidence that NICE take much more seriously.
“YouGov’s recent Public Perceptions Survey saw 85% of respondents say it is important that counselling or psychotherapy should be accessible to everyone who wants it, so we know that counselling is a treatment that patients want. The results of PRaCTICED show that it is just as effective as other treatments that have been offered ahead of PCET/CfD in IAPT services. The PRaCTICED trial findings support our campaigning for patients and clients to have a better choice of treatment and show that there is no reason why PCET should not be offered on an equal basis as a front-line intervention.”
Why the research was carried out
When the IAPT programme was launched in 2008, CBT was recommended as the first line treatment for anxiety and depression. As IAPT developed and expanded it was recommended that PCET/CfD, alongside other non-CBT approaches, also be made available for people accessing services. However, reflecting the NICE Guideline for Depression in Adults at the time, it was recommended that PCET only be offered as a second line treatment for adults with depression and with a caveat that providers should discuss with clients the ‘uncertainty’ of the effectiveness of counselling before offering it.
These recommendations were based on an interpretation of research evidence that privileged studies demonstrating the effectiveness of CBT; an exclusive model of evidence interpretation we have continuously and strenuously challenged.
As a result, we commissioned the PRaCTICED trial to contribute to the evidence base for PCET in language that NICE will value – randomised controlled trials.
In addition to contributing to the evidence base for PCET, the results from the trial also further challenge NICE’s hierarchy of evidence, with the findings of the trial producing similar conclusions as previous evaluations of client outcome data from IAPT services. We believe that research on large routine outcome datasets, as well as qualitative research about client experiences and preferences, should be included by NICE when recommending interventions.
As demand for psychological therapies increases and the importance of patient choice becomes more prominent, NICE develops and updates its recommendations for treatment options. These are based on a narrow definition of what constitutes appropriate research evidence.
How it was carried out
The trial, which recruited clients in Sheffield between 2014 and 2018, aimed to determine the clinical efficacy and cost-effectiveness of PCET compared to CBT in the treatment of moderate and severe depression. Ethical approval for the study was granted by the Health Research Authority.
A total of 510 participants, aged 18 or over, were recruited to the trial and were assessed as meeting a diagnosis of either moderate or severe depression.
Patients were randomly assigned to PCET or CBT and received upwards of 20 sessions in the Sheffield IAPT service. Standardised measures that are used routinely in IAPT services were used to measure recovery at six months and 12 months after they entered the trial as well as at the end of treatment.
The most important finding from the study was that it found no evidence of any meaningful difference in the outcomes that participants achieved between PCET and CBT either at six months after entering the trial or at the end of their therapy. This finding held across a range of outcome measures and the evidence strongly suggests that PCET is as effective as CBT in the treatment of depression in the short-term.
However, 12 months after entering treatment, the trial found that outcomes favoured the CBT group, particularly for clients who presented with more severe depression. This suggests that further research is needed to learn more about these differences.
Overall, the trial found that there was no difference in cost-effectiveness between PCET and CBT treatments
These are incredibly important findings as they confirm the need for continued investment in the training and delivery of PCET.
Professor Michael Barkham said: “This is an important study made possible by the collaboration of our partner institutions, particularly the Sheffield IAPT service. The resulting evidence from the PRaCTICED trial complements and builds on findings derived from routine IAPT datasets. However, a single trial is not sufficient. There needs to be a concerted effort towards funding and conducting additional studies that support the training and delivery of evidence-based models of therapy that provide people in need with choice.”
Read the full paper in The Lancet Psychiatry