Cognitive analytic therapy in obsessive spectrum, anxiety and depression disorders: a systematic review

Currently, the high demand in the health system leads to considering short-term interventions that allow greater efficiency in the psychotherapeutic approach. Cognitive Analytic Therapy (CAT) is a brief psychotherapy, created in the United Kingdom by Anthony Ryle in 1992 [1], that combines cognitive, psychoanalytic, and behavioral concepts, among other approaches. As Ryle points out, it is an integrative, focused, and time-limited therapy that responds to the needs of public mental health systems. In this work, focusing on daily clinical work, we aim to review the literature on the application of this therapy model in highly prevalent disorders with a significant degree of functional limitation and disability in the public health system, such as anxiety and depression disorders and obsessive spectrum disorders. This work is the only one in the available literature that brings together most of the cases with diagnoses belonging to the obsessive spectrum in which cognitive analytical therapy has been applied.

The objective of this study is to determine if cognitive analytical therapy could be a feasible option for reducing the symptoms of anxiety, depression and obsessive spectrum disorders.

To this end, a systematic review of the scientific literature in the last 30 years up to April 2024 has been carried out in MEDLINE/PubMed, Dialnet, PsycINFO and Web of Science. This was complemented by a manual search of reference lists included in relevant articles and reviews on the subject. After screening the studies, ten articles were finally selected that met the requirements to answer the objectives set out in this work.

The results of the ten studies included in our review reflect beneficial effects of the therapy in terms of reducing symptoms of anxiety, depression and obsessive spectrum disorders, as well as, in comparison with other established therapeutic models. On the one hand, it is clear that, at the level of the obsessive spectrum, all articles agree on a reduction in symptoms after cognitive analytic therapy. On the other hand, regarding depressive symptoms, studied in eight of the ten included studies, a reduction in symptoms was found in all of them. However, only one study showed no significant differences between cognitive analytic therapy and cognitive behavioral therapy, nor for anxiety symptoms. Nevertheless, we consider this finding a point in favor of the therapy, because it compares eight sessions of cognitive analytic therapy with a widely established model, achieving similar results. Regarding anxiety symptoms, studied in six of the ten studies included, five of them showed a reduction in anxiety symptoms after the use of cognitive analytic therapy. These results support previous evidence gathered in other studies that determined that cognitive analytic therapy was an effective psychotherapeutic approach in the pathologies studied.

In the future, larger and higher quality studies with more standardized measurement instruments are necessary; however, this review provides talented results on the use of this therapy in the mentioned disorders.

References

Ryle, A., Spencer, J. & Yawetz, C. (1992), When Less Is More Or At Least Enough Two Case Examples of 16-Session Cognitive Analytic Therapy. British Journal of Psychotherapy, 8: 401-412. https://doi.org/10.1111/j.1752-0118.1992.tb01202.x