Development and piloting of a cognitive analytic therapy guided self-help (CAT-GSH) for depression in NHS Talking Therapies

Objectives: The Medical Research Council’s complex intervention framework (CIF) was used to develop and pilot CAT-GSH for depression in terms of acceptability and effectiveness.

Design: A parallel mixed-methods case series with session-by-session outcome measurement alongside patient and staff interviewing.

Methods: Stage one of the CIF used deductive and inductive strategies to develop the intervention. Stage two of the CIF recruited four Psychological Wellbeing Practitioners (PWPs) and 11 patients to pilot the intervention in an England NHS Talking Therapy service. Acceptability was assessed via uptake rates, dropout, and sessional attendance, plus structured interviews with PWPs and patients that were analysed with framework analysis. Effectiveness was assessed by calculating reliable and clinically significant change rates on sessional clinical outcomes (PHQ-9, GAD-7 and WSAS).

Results: Depression and anxiety significantly reduced between screening and termination, and screening and follow-up. Seven of the 11 patients reliably recovered at follow-up. All patients offered CAT-GSH accepted, and one patient dropped out. Patients found CAT-GSH to be a mostly acceptable experience in which their mood improved, as recognition skills improved, and they were able to implement exits. Facilitators also found CAT-GSH to be an acceptable treatment for NHS Talking Therapies, which provide them with professional development opportunities alongside improving patient’s choice.

Conclusions: CAT-GSH appears acceptable and demonstrates promising preliminary findings for reducing symptoms of depression. Further research is needed to evaluate the intervention in the next stages of the CIF which entails more controlled evaluations.