Multi-site randomised controlled trial of outcome feedback technology used to support the psychological treatment of depression and anxiety

Background: Previous research suggests that using outcome feedback technology can enable psychological therapists to identify and resolve obstacles to clinical improvement. This study aimed to evaluate the effectiveness of an outcome feedback quality assurance system applied in stepped care psychological services. Methods: This multi-site cluster randomised controlled trial (registration DOI: 10.1186/ISRCTN12459454) included 2233 patients with depression and anxiety disorders accessing at least 2 sessions of individual psychological therapy delivered by 77 therapists across 8 healthcare organisations. Therapists were randomised to a feedback intervention group (N = 39) or a treatment-as-usual control group (N = 38). The feedback technology alerted therapists to cases that were “not on track”, and primed them to review these in clinical supervision. Posttreatment symptom severity on validated depression (PHQ-9) and anxiety (GAD-7) measures was compared between groups using multilevel modelling, controlling for cluster (therapist) effects, following an intention-to-treat approach. Findings: Cases classified as not on track had significantly less severe symptoms after treatment if they were allocated to the feedback group (PHQ-9 d = 0.23, B = - 1.03 [95% CI = -1.84, -0.23], p = 0.012; GAD-7 d = 0.19, B = -0.85 [95% CI = -1.56, -0.14], p = 0.019). There were no between-group differences in the odds of reliable improvement (OR = 1.32 [0.93, 1.89], p = 0.12); however, control cases classed as not on track had significantly greater odds of reliable deterioration (OR = 1.73 [1.18, 2.54], p = 0.0050). Interpretation: Supplementing psychological therapy with low-cost feedback technology prevents deterioration in cases at risk of poor response to treatment. This evidence supports the implementation of outcome feedback in stepped care psychological services.