Cognitive Analytic Therapy & Cognitive Behavioural Therapy for affective disorders: A feasibility randomised controlled trial

Background information

Chanen et. al. (2008) - This RCT investigated CAT for adolescents at risk of developing borderline personality disorders. They found CAT had a more rapid benefit as an early intervention treatment than standardised good clinical care.

Fosbury et. al. (1997) - Compared CAT and diabetes specialist nurse education (DSNE) for adults with poorly controlled type 1 diabetes. CAT produced a more long term improvement on glycemic control and interpersonal difficulties.

Marriott and Kellett (2009) - Compared CAT with CBT and Person-centered therapy (PCT) for adults with anxiety and mood disorders. All three therapies were found to be equally effective. However, this study was limited because participants were not randomly allocated to therapy and there was also no effort to standardise assessment procedure or therapy delivery.

Research Rationale

  • Access to Psychological Therapies is limited in the National Health Service (NHS), despite this being a top priority.
  • CBT is the most commonly used therapy and has the largest evidence base. However, it not suitable for everyone and many drop out (Churchill et. al., 2001).
  • The National Institute of Clinical Excellence (NICE) endorse alternative therapies to CBT for affective disorders but as yet there is limited evidence for these.
  • CAT is used extensively in the NHS despite having a limited evidence base. This feasibility study aims to discover whether an RCT of CAT and CBT is possible.

Research Questions

  • Can CBT and CAT therapists work together to identify clients whom they consider can be effectively treated by either therapy and thus randomly allocate them to CAT or CBT?
  • Will clients consent to randomisation and co-operate with research interviews?
  • Can the therapies be conducted within a research framework, including structured follow up?
  • What would be the requirements for effective trial?


Design: Feasibility Randomised Controlled Trial (RCT) in a clinical NHS Psychological Services.
Sample: 40 participants referred to Oxford Health Psychological Services.

Inclusion 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

Eleven CAT and CBT therapists in Oxford Health NHS FT are committed to the trial and will conduct clinical assessments and deliver therapy to study participants.

Research Measures - A number of research measures are administered in an hour long interview conducted by an trained independent researcher.
Self-rated – Medical Outcomes Scale, Social Adjustment Scale, Beck Anxiety & Depression Scales, Clinical Outcomes in Routine Evaluation.

Interviewer rated – Mini-International Neuropsychiatric Interview, Hamilton Anxiety and Hamilton Depression Scales.

Since the end of October 2010 we have recruited seven participants. We also have eleven therapists from Oxford Health Psychological Services committed to the study. So far all those recruited by therapists during assessments have agreed to meet with the Research Assistant and have consented to take part in the research. Two participants have been had their T2 interview and have begun their therapy.

Catriona Anderson1, Ksenija Yeeles1, Tom Burns1, Glenys Parry2, John Geddes1, David Westbrook3, Eva Burns-Lundgren3, Yvonne Taylor3.

Social Psychiatry Group, Department of Psychiatry, University of Oxford, 2School of Health and Related Research, University of Sheffield and Oxford Health NHS Foundation Trust
For more information contact Cate Anderson at
April 2011

November 2014 Update:
Research complete but yet to be published

ACAT Calendar for March
22nd March 2018
CPD Event: Youth CAT CPD Day & AGM - Re-integrating Youth
99th March 2018
CPD Event: ACAT: CAT and the Embodied Mind
1717th March 2018
CPD Event: The Psychotherapist's Self-Care - offered by Confer
1919th March 2018
CPD Event: States, Self-states and State Shifts - offered by Catalyse
2121st March 2018
CPD Event: ACAT's Annual Meeting of Trainers and Supervisors

More information:

Current Research Using a CAT approach to make sense of psychosis Team based Interventions with 5 session CAT consultancy RCT of CAT with adolescent and borderline patients Integrating Embodied Awareness into CAT Comparison of Treatment of Anorexia in Adults with CAT Case Series Research - in intellectual disability (community and forensic) services Research Awaiting Publication Deconstruction of CAT The case formulation task in psychotherapy Therapists’ Construction and Application of the Reformulation Diagram in Clinical Practice Understanding SDRs in CAT CAT Sequential Diagrammatic Reformulation (SDR) to explore service users' experience of CAT formulation: a qualitative thesis project Recently Published Research and Research Presentations A Feasibility Trial of Group Cognitive Analytic Music Therapy in Secure Hospital Settings (2014) Assessment of identity disturbance: Factor Structure and validation of the Personality Structure Questionnaire (PSQ) in an Italian sample CAT and Psychosis Cognitive Analytic Therapy for high-risk sexual behaviour Is Cognitive Analytic Therapy (CAT) effective in treating Hoarding Disorder? Testing the Effectiveness of Cognitive Analytic Therapy for Hypersexuality Disorder: An Intensive Time-Series Evaluation Cognitive analytic therapy: A review of the outcome evidence base for treatment Group Cognitive Analytic Therapy for Female Survivors of Childhood Sexual Abuse An eight-eyed version of Hawkins and Shohet’s clinical supervision model: the addition of the cognitive analytic therapy concept of the ‘observing eye/I’ as the ‘observing us’ Outcomes of cognitive analytic therapy delivered by trainees Treatment of Paranoid Personality Disorder with Cognitive Analytic Therapy - A Mixed Methods Single Case Experimental Design Team Consultancy Using Cognitive Analytic Therapy: A Controlled Study In Assertive Outreach Using a cognitive analytic approach to formulate a complex sexual and violent offender to inform multi-agency working: developing a shared understanding Cognitive analytic therapy at 30 Bipolar Trial: CATBiD: A phase one randomised controlled study of Cognitive Analytic Therapy for Bipolar Affective Disorder Development and evaluation of cognitive analytic guided self-help (CAT-SH) for use in IAPT services How change is enabled during cognitive analytic therapy: An exploratory study of the treatment of depression CAT Research Archives Do people with learning disabilities have a concept of reciprocal roles Exploring endings from therapist's experience RCT for CAT and diabetes A process study evaluating rupture repair in CAT CAT in groups The SPeDi Trial (Sheffield Personality Disorders) Goodbye Letters in CAT The effectiveness of CAT for BPD RCT for CAT informed care planning CAT and CBT for affective disorders Key References to Research in CAT Support for CAT research Research and Communication Committee

Contact Details

ACAT Administration Manager:Maria Cross

ACAT Administrator:Alison Marfell

ACAT Financial Administrator:Louise Barter

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Phone:+44(0) 1305 263 511

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