The Nottingham Study of Neurotic Disorder: influence of cognitive therapists on outcome

In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive-behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive-behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.

The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM-III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist.

The patients treated by competent therapists (n = 30) generally showed greater improvement than those allocated to therapists of uncertain competence (n = 40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive-behaviour therapy had been completed.

Cognitive-behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.