The effectiveness of brief cognitive analytic therapy for anxiety and depression: A quasi-experimental case-control study

Br J Clin Psychol. 2021 Jun;60(2):194-211. doi: 10.1111/bjc.12278. Epub 2021 Jan 17.


Objectives: To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT).

Methods: The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N = 76) and CBT (N = 73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies.

Results: LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between-therapy post-treatment effects and medium-to-large within-therapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower.

Conclusions: Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed.

Practitioner points: Practitioners (under appropriate supervision) could use 8-session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8-session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity.

Keywords: CAT; CBT; IAPT; psychotherapy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / therapy*
  • Case-Control Studies
  • Cognitive Behavioral Therapy / methods*
  • Depression / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Non-Randomized Controlled Trials as Topic
  • Propensity Score
  • Treatment Outcome
  • Young Adult