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?
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.