Question: In adults with depression, how effective is cognitive behavioural therapy (CBT) delivered by paraprofessionals, compared to CBT delivered by trained professionals, in improving patient outcomes?

Answer:

From the five included trials there was only one which directly compared the delivery of CBT by paraprofessionals and professional therapists. This was conducted in the US and found that significantly more participants receiving professional therapy were classified as non-depressed and alleviated (based on BDI scores). However, it was a poor quality trial and had some methodological and reporting limitations. There was one moderate quality trial evaluating paraprofessional delivered CBT, and three trials (one high and two moderate quality) evaluating professional delivered CBT , all compared with usual care or a waiting list control. These four trials all found some statistically significant benefits for the intervention on symptoms of depression, anxiety or general quality of life.

This evidence confirms the NICE recommendation that "Uncertainty remains about the accuracy and consequent identification of appropriate treatment by paraprofessionals in primary care". There is a need for more research into therapies delivered by paraprofessionals using high quality randomised controlled trials, with relevant patient outcome measures, health economic analyses, and sufficient follow-up durations. The trials reviewed for this question were all fairly small (between 40 and 122 participants) and did not follow-up participants beyond six months.