Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: Impact of content and quality on outcomes in a systematic review

Katrina Witt, Daniela Pache de Moraes, Tatiana Taylor Salisbury, Ella Aren s man, David Gunnell, Philip Hazell, Ellen Townsend, Kees van Heeringen, Keith Hawton

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. Methods: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. Results: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15–0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). Limitations: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. Conclusions: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.

Original languageEnglish
Pages (from-to)434-447
Number of pages14
JournalJournal of Affective Disorders
Volume235
DOIs
Publication statusPublished - 1 Aug 2018
Externally publishedYes

Keywords

  • Clinical trials
  • Methodology
  • Self-harm
  • Suicide
  • Treatment as usual

Cite this

Witt, Katrina ; de Moraes, Daniela Pache ; Salisbury, Tatiana Taylor ; Aren s man, Ella ; Gunnell, David ; Hazell, Philip ; Townsend, Ellen ; van Heeringen, Kees ; Hawton, Keith. / Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm : Impact of content and quality on outcomes in a systematic review. In: Journal of Affective Disorders. 2018 ; Vol. 235. pp. 434-447.
@article{1ce8a97e1132497ab2f81fa8f64b9d59,
title = "Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: Impact of content and quality on outcomes in a systematic review",
abstract = "Background: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. Methods: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. Results: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95{\%} Confidence Interval 0.15–0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95{\%} CI 0.63 to 0.97; 12 trials). Limitations: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. Conclusions: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.",
keywords = "Clinical trials, Methodology, Self-harm, Suicide, Treatment as usual",
author = "Katrina Witt and {de Moraes}, {Daniela Pache} and Salisbury, {Tatiana Taylor} and {Aren s man}, Ella and David Gunnell and Philip Hazell and Ellen Townsend and {van Heeringen}, Kees and Keith Hawton",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.jad.2018.04.025",
language = "English",
volume = "235",
pages = "434--447",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm : Impact of content and quality on outcomes in a systematic review. / Witt, Katrina; de Moraes, Daniela Pache; Salisbury, Tatiana Taylor; Aren s man, Ella; Gunnell, David; Hazell, Philip; Townsend, Ellen; van Heeringen, Kees; Hawton, Keith.

In: Journal of Affective Disorders, Vol. 235, 01.08.2018, p. 434-447.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm

T2 - Impact of content and quality on outcomes in a systematic review

AU - Witt, Katrina

AU - de Moraes, Daniela Pache

AU - Salisbury, Tatiana Taylor

AU - Aren s man, Ella

AU - Gunnell, David

AU - Hazell, Philip

AU - Townsend, Ellen

AU - van Heeringen, Kees

AU - Hawton, Keith

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. Methods: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. Results: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15–0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). Limitations: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. Conclusions: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.

AB - Background: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. Methods: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. Results: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15–0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). Limitations: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. Conclusions: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.

KW - Clinical trials

KW - Methodology

KW - Self-harm

KW - Suicide

KW - Treatment as usual

UR - http://www.scopus.com/inward/record.url?scp=85045538008&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2018.04.025

DO - 10.1016/j.jad.2018.04.025

M3 - Review Article

VL - 235

SP - 434

EP - 447

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -