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Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial

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  • Jaime Delgadillo
  • Kim de Jong
  • Mike Lucock
  • Wolfgang Lutz
  • Julian Rubel
  • Simon Gilbody
  • Shehzad Ali
  • Elisa Aguirre
  • Mark Appleton
  • Jacqueline Nevin
  • Harry O’Hayon
  • Ushma Patel
  • Andrew Sainty
  • Peter Spencer
  • Dean McMillan


Publication details

JournalThe Lancet Psychiatry
DateAccepted/In press - 12 Apr 2018
DateE-pub ahead of print - 21 Jun 2018
DatePublished (current) - Jul 2018
Issue number7
Number of pages9
Pages (from-to)564-572
Early online date21/06/18
Original languageEnglish


Background: Previous research suggests that using outcome feedback technology
can enable psychological therapists to identify and resolve obstacles to clinical
improvement. This study aimed to evaluate the effectiveness of an outcome
feedback quality assurance system applied in stepped care psychological services.
Methods: This multi-site cluster randomised controlled trial (registration DOI:
10.1186/ISRCTN12459454) included 2233 patients with depression and anxiety
disorders accessing at least 2 sessions of individual psychological therapy
delivered by 77 therapists across 8 healthcare organisations. Therapists were
randomised to a feedback intervention group (N = 39) or a treatment-as-usual
control group (N = 38). The feedback technology alerted therapists to cases that
were “not on track”, and primed them to review these in clinical supervision. Posttreatment
symptom severity on validated depression (PHQ-9) and anxiety (GAD-7)
measures was compared between groups using multilevel modelling, controlling
for cluster (therapist) effects, following an intention-to-treat approach.
Findings: Cases classified as not on track had significantly less severe symptoms
after treatment if they were allocated to the feedback group (PHQ-9 d = 0.23, B = -
1.03 [95% CI = -1.84, -0.23], p = 0.012; GAD-7 d = 0.19, B = -0.85 [95% CI = -1.56,
-0.14], p = 0.019). There were no between-group differences in the odds of reliable
improvement (OR = 1.32 [0.93, 1.89], p = 0.12); however, control cases classed as
not on track had significantly greater odds of reliable deterioration (OR = 1.73 [1.18,
2.54], p = 0.0050).
Interpretation: Supplementing psychological therapy with low-cost feedback
technology prevents deterioration in cases at risk of poor response to treatment.
This evidence supports the implementation of outcome feedback in stepped care
psychological services.

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© 2018 Elsevier Ltd. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

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