Question: In adults with anxiety and, how effective is cognitive behavioural therapy (CBT) delivered by paraprofessionals, compared to CBT delivered by trained professionals, in improving patient outcomes, specifically, reducing symptoms and distress and improving quality of life, employment and social adjustment?

Answer:

There was no evidence on the effectiveness of CBT delivered by paraprofessionals, compared to CBT delivered by trained professionals, for the treatment of adults with anxiety. Two small RCTs provided some evidence indicating that CBT interventions delivered by paraprofessionals or therapists with minimal experience of CBT may be similarly effective to treatment as usual, which could include (un-specified) psychological therapies, for reducing symptoms and improving quality of life in people with mild to moderate anxiety over the short (1-3 months) and long (1-2 years) term. Data from one poor quality RCT indicated that therapist competence, but not therapist CBT adherence, may be predictive of clinical outcome; this study also noted the importance of initial training. We identified one systematic review which assessed the effectiveness of psychological treatments for anxiety and depressive disorders performed by paraprofessionals, however, this review included only five studies and was excluded from this evidence summary as it did not include any studies of CBT interventions for anxiety. There is a need for studies which directly compare the effectiveness of CBT interventions delivered by different types of practitioners.