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Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:869-880. [PMID: 33564943 PMCID: PMC8042082 DOI: 10.1007/s11606-020-06449-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the efficacy of self-help cognitive-behavioral therapy (CBT) for depression has been well established, its feasibility in primary care settings is limited because of time and resource constraints. The goal of this study was to identify common elements of empirically supported (i.e., proven effective in controlled research) self-help CBTs and frameworks for effective use in practice. METHODS Randomized controlled trials (RCTs) for self-help CBTs for depression in primary care were systematically identified in Pubmed, PsycINFO, and CENTRAL. The distillation and matching model approach was used to abstract commonly used self-help techniques (practice elements). Study contexts associated with unique combinations of intervention elements were explored, including total human support dose (total face-to-face, telephone, and personalized email contact time recommended by the protocol), effective symptom domain (depression vs. general psychological distress), and severity of depression targeted by the study. Relative contribution to intervention success was estimated for individual elements and human support by conditional probability (CP, proportion of the number of times each element appeared in a successful intervention to the number of times it was used in the interventions identified by the review). RESULTS Twenty-one interventions (12 successful) in 20 RCTs and 21 practice elements were identified. Cognitive restructuring, behavioral activation, and homework assignment were elements appearing in > 80% of successful interventions. The dose of human support was positively associated with the proportion of interventions that were successful in a significant linear fashion (CPs: interventions with no support, 0.20; 1-119 min of support, 0.60; 120 min of support, 0.83; p = 0.042). In addition, human support increased the probability of success for most of the extracted elements. Only social support activation, homework assignment, and interpersonal skills were highly successful (CPs ≥ 0.60) when minimal support was provided. DISCUSSION These findings suggest that human support is an important component in creating an evidence-informed brief self-help program compatible with primary care settings.
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McCashin D, Coyle D, O'Reilly G. A qualitative evaluation of Pesky gNATs in primary care - The experiences of assistant psychologists providing computer-assisted CBT to children experiencing low mood and anxiety. Internet Interv 2020; 22:100348. [PMID: 32904717 PMCID: PMC7458094 DOI: 10.1016/j.invent.2020.100348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Technology-assisted cognitive behavioural therapy (CBT) is recognized as an evidence-based and cost-effective way to address psychological difficulties in children. Increasingly, these interventions are provided by staff with different levels of psychological training, such as assistant psychologists (APs). However, there is limited qualitative understanding regarding their experiences of providing technology-assisted CBT. METHOD Semi-structured interviews were conducted with APs (n = 14) in primary care settings in Ireland. This qualitative evaluation is part of an ongoing RCT for the CBT game Pesky gNATs (O'Reilly and Coyle, 2015). All data were inductively analysed using qualitative thematic analysis by Braun and Clarke (2006). RESULTS Five overarching themes were identified: 1) positive experiences, 2) integrating Pesky gNATs with traditional CBT, 3) managing parental 'buy-in', 4) implementation complexities, and 5) future perspectives. Two subthemes were reported for each overarching theme: benefits for children, AP professional growth, facilitating engagement, different child characteristics, unclear role for parents, child autonomy, managing waitlists, external factors, design considerations and advice to future APs. CONCLUSIONS Pesky gNATs is well-received by APs in primary care, and is mostly experienced as helpful by both APs and children. However, a number of factors may be impacting the ability of APs to effectively provide the intervention.
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Affiliation(s)
- Darragh McCashin
- University College Dublin, School of Psychology, Dublin, Ireland
- Corresponding author.
| | - David Coyle
- University College Dublin, School of Computer Science, Dublin, Ireland
| | - Gary O'Reilly
- University College Dublin, School of Psychology, Dublin, Ireland
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Gili M, Castro A, García-Palacios A, Garcia-Campayo J, Mayoral-Cleries F, Botella C, Roca M, Barceló-Soler A, Hurtado MM, Navarro M, Villena A, Pérez-Ara MÁ, Riera-Serra P, Baños RM. Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial. J Med Internet Res 2020; 22:e15845. [PMID: 32501276 PMCID: PMC7305559 DOI: 10.2196/15845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/03/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches. Objective This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]). Methods A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months’ follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages. Results A moderate decrease was detected in PHQ-9 scores from HLP (β=–3.05; P=.01) and MP (β=–3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment. Conclusions The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions. Trial Registration ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279 International Registered Report Identifier (IRRID) RR2-10.1186/s12888-015-0475-0
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Affiliation(s)
- Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria Illes Balears, Palma de Mallorca, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Adoración Castro
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Azucena García-Palacios
- Department of Clinical and Basic Psychology and Biopsychology, Faculty of Health Sciences, Univeristy Jaume I, Castellón, Spain.,Biomedical Research Center Network (CIBER) Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
| | - Javier Garcia-Campayo
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.,Departament of Psychiatry, Hospital Miguel Servet, University of Zaragoza, Zaragoza, Spain
| | - Fermin Mayoral-Cleries
- Mental Heath Unit, Hospital Regional of Malaga, Biomedicine Research Institute (IBIMA), Málaga, Spain
| | - Cristina Botella
- Department of Clinical and Basic Psychology and Biopsychology, Faculty of Health Sciences, Univeristy Jaume I, Castellón, Spain.,Biomedical Research Center Network (CIBER) Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
| | - Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria Illes Balears, Palma de Mallorca, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | | | - María M Hurtado
- Mental Heath Unit, Hospital Regional of Malaga, Biomedicine Research Institute (IBIMA), Málaga, Spain
| | - MªTeresa Navarro
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Amelia Villena
- Mental Health Unit of Pozoblaco, Hospital Los Pedroches, Córdoba, Spain
| | - M Ángeles Pérez-Ara
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Pau Riera-Serra
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria Illes Balears, Palma de Mallorca, Spain
| | - Rosa Mª Baños
- Biomedical Research Center Network (CIBER) Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain.,Department of Psychological, Personality, Evaluation and Treatment, University of Valencia, Valencia, Spain
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Gualano MR, Bert F, Martorana M, Voglino G, Andriolo V, Thomas R, Gramaglia C, Zeppegno P, Siliquini R. The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials. Clin Psychol Rev 2017; 58:49-58. [PMID: 28993103 DOI: 10.1016/j.cpr.2017.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy. METHODS After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool. RESULTS Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3months to 3years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results. CONCLUSION Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Torino, Italy.
| | - F Bert
- Department of Public Health Sciences, University of Torino, Italy
| | - M Martorana
- Department of Public Health Sciences, University of Torino, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Torino, Italy
| | - V Andriolo
- Department of Public Health Sciences, University of Torino, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Torino, Italy
| | - C Gramaglia
- Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - P Zeppegno
- Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Torino, Italy
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Siller H, Renner W, Juen B. Turkish Migrant Women with Recurrent Depression: Results from Community-based Self-help Groups. Behav Med 2017; 43:129-141. [PMID: 26651367 DOI: 10.1080/08964289.2015.1111858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study focuses on psychosocial functioning of female Turkish immigrants in Austria with recurrent depressive disorder participating in self-help groups. Self-help groups guided by group leaders of Turkish descent should increase autonomy in participants, providing the opportunity to follow their ethnic health beliefs. Turkish immigrant women (n = 43) with recurrent depressive disorder participated in self-help groups over four months. Qualitative data of participants and group leaders, containing interviews, group protocols and supervision protocols of group leaders were analyzed using the qualitative content analysis for effects on psychosocial function, such as interaction with others, illness beliefs and benefit from self-help group. Women reported feelings of being neglected and violated by their husbands. They stated that they had gained strength and had emancipated themselves from their husbands. Self-help groups functioned as social resources and support for changes in participants' lives. Further interventions should integrate the functional value of depressive symptoms and focus on social support systems and social networks.
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Affiliation(s)
- Heidi Siller
- a Women's Health Centre , Medical University of Innsbruck
| | | | - Barbara Juen
- c Department of Psychology , University of Innsbruck
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Van den Broeck K, Remmen R, Vanmeerbeek M, Destoop M, Dom G. Collaborative care regarding major depressed patients: A review of guidelines and current practices. J Affect Disord 2016; 200:189-203. [PMID: 27136418 DOI: 10.1016/j.jad.2016.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major Depressive Disorder (MDD) is a severe and common mental disorder. A growing body of evidence suggests that stepped and/or collaborative care treatment models have several advantages for severely depressed patients and caretakers. However, despite the availability of these treatment strategies and guidance initiatives, many depressive patients are solely treated by the general practitioner (GP), and collaborative care is not common. In this paper, we review a selected set of international guidelines to inventory the best strategies for GPs and secondary mental health care providers to collaborate when treating depressed patients. Additionally, we systematically searched the literature, listing potential ways of cooperation, and potentially supporting tools. We conclude that the prevailing guidelines only include few and rather vague directions regarding the cooperation between GPs and specialised mental health practitioners. Inspiring recent studies, however, suggest that relatively little efforts may result in effective collaborative care and a broader implementation of the guidelines in general.
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Affiliation(s)
- Kris Van den Broeck
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.
| | - Roy Remmen
- General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Marc Vanmeerbeek
- Département de Médecine Générale, University of Liège, Liège, Belgium
| | - Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; Psychiatric Centre Brothers Alexianen, Boechout, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; Psychiatric Centre Brothers Alexianen, Boechout, Belgium
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7
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Bachem R, Maercker A. Self-help interventions for adjustment disorder problems: a randomized waiting-list controlled study in a sample of burglary victims. Cogn Behav Ther 2016; 45:397-413. [DOI: 10.1080/16506073.2016.1191083] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Taleban R, Zamani A, Moafi M, Jiryaee N, Khadivi R. Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms. Int J Prev Med 2016; 7:46. [PMID: 27076884 PMCID: PMC4809119 DOI: 10.4103/2008-7802.177889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/02/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. METHODS This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. RESULTS Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. CONCLUSIONS It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.
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Affiliation(s)
- Roya Taleban
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Zamani
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Moafi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Jiryaee
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Khadivi
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Experiences and attitudes of primary care therapists in the implementation and use of internet-based treatment in Swedish primary care settings. Internet Interv 2015. [DOI: 10.1016/j.invent.2015.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Naeem F, Xiang S, Munshi TA, Kingdon D, Farooq S. Self-help and guided self-help interventions for schizophrenia and related disorders. Hippokratia 2015. [DOI: 10.1002/14651858.cd011698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Farooq Naeem
- Queen's University; Department of Psychiatry; Kingston ON Canada
| | - Shuo Xiang
- Queen's University; Department of Psychiatry; Kingston ON Canada
| | - Tariq A Munshi
- Kingston General Hospital; Department of Psychiatry; Frontenac Clinical Services 385 Princess Street Kingston UK ON K7L 1B9
| | - David Kingdon
- University of Southampton; Mental Health Group; College Keep 4-12 Terminus Terrace Southampton UK SO14 3DT
| | - Saeed Farooq
- Staffordshire University & Black Country Social Partnership NHS Foundation Trust; Centre for Ageing and Mental Health; Dunstall Road Wolverhampton UK WV6 0NZ
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Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
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Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
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Twomey C, O'Reilly G, Byrne M. Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract 2015; 32:3-15. [PMID: 25248976 DOI: 10.1093/fampra/cmu060] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT's effectiveness across delivery formats in primary care. OBJECTIVE To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care. METHODS A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. RESULTS Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multi-modal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37). CONCLUSIONS The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT's economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.
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Affiliation(s)
- Conal Twomey
- School of Psychology, University College Dublin, Dublin, Ireland, School of Psychology, University of Southampton, Southampton, UK
| | - Gary O'Reilly
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Michael Byrne
- Psychology Department, Health Service Executive Dublin Mid-Leinster, Offaly, Ireland
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Abstract
AbstractEarly intervention in depression is important for many reasons including expeditious alleviation of suffering, assisting parenthood, suicide prevention and helping the economy. The fact that people with depression frequently employ maladaptive coping strategies, notably alcohol misuse, suggests the need for evidence-based self-help for sufferers. Self-help can be viewed as a philosophy of patient empowerment and as “a health technology solution to volume and demand”. Bibliotherapy (self-help using written materials) provides information and encourages the reader to make changes leading to improved self-management. Enthusiasm for the use of bibliotherapy in depression should be tempered by pursuit of a sound evidence base.
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14
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Kivi M, Eriksson MCM, Hange D, Petersson EL, Vernmark K, Johansson B, Björkelund C. Internet-based therapy for mild to moderate depression in Swedish primary care: short term results from the PRIM-NET randomized controlled trial. Cogn Behav Ther 2014; 43:289-98. [PMID: 24911260 PMCID: PMC4260664 DOI: 10.1080/16506073.2014.921834] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in "real world" primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale - self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.
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Affiliation(s)
- Marie Kivi
- a Department of Psychology , University of Gothenburg , Gothenburg , Sweden
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Lessons from community mental health to drive implementation in health care systems for people with long-term conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4714-28. [PMID: 24785742 PMCID: PMC4053874 DOI: 10.3390/ijerph110504714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 12/30/2022]
Abstract
This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.
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A qualitative study of clinicians’ experiences and attitudes towards telephone triage mental health assessments. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x13000226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis qualitative study investigated clinicians’ experiences and attitudes towards conducting mental health assessments over the telephone in an IAPT service. Nine participants completed a semi-structured questionnaire and data were evaluated using a Thematic Analysis model. Participants were largely apprehensive about telephone working, but many reported positive experiences. Telephone assessments were felt to be structured, focused and comprehensive, and therapeutic rapport was able to be established. However, concerns persisted around whether risk assessments could be adequately conducted over the telephone. Reports of spontaneous feedback from patients during telephone triage suggested that there was appreciation for this method of assessment and that it increased access to the service. Further research is needed to better understand what, for clinicians, contributes to acceptable assessment of complex and subjective situations, such as risk and feeling states, over the telephone.
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Park SC, Oh HS, Oh DH, Jung SA, Na KS, Lee HY, Kang RH, Choi YK, Lee MS, Park YC. Evidence-based, non-pharmacological treatment guideline for depression in Korea. J Korean Med Sci 2014; 29:12-22. [PMID: 24431900 PMCID: PMC3890462 DOI: 10.3346/jkms.2014.29.1.12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/16/2013] [Indexed: 11/20/2022] Open
Abstract
Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the 'Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea
- Institute of Mental Health, Hanyang University, Seoul, Korea
| | - Hong Seok Oh
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea
| | - Dong-Hoon Oh
- Institute of Mental Health, Hanyang University, Seoul, Korea
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Korea
| | - Seung Ah Jung
- Department of Counseling Psychology, Chosun University, Gwangju, Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hwa-Young Lee
- Department of Psychiatry, College of Medicine, Soonchunhyang University, Asan, Korea
| | | | - Yun-Kyeung Choi
- Department of Psychology, College of Humanities, Keimyung University, Daegu, Korea
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Yong Chon Park
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea
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Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013:CD005330. [PMID: 24018460 DOI: 10.1002/14651858.cd005330.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anxiety disorders are the most common mental health problems. They are chronic and unremitting. Effective treatments are available, but access to services is limited. Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies. OBJECTIVES To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults. SEARCH METHODS Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data. SELECTION CRITERIA Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy. DATA COLLECTION AND ANALYSIS Both review authors independently screened titles and abstracts. Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted. We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used. MAIN RESULTS One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking. AUTHORS' CONCLUSIONS Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited. Most interventions tested are not available to consumers. Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established. Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.
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Affiliation(s)
- Evan Mayo-Wilson
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK, WC1E 7HB
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Bower P, Kontopantelis E, Sutton A, Kendrick T, Richards DA, Gilbody S, Knowles S, Cuijpers P, Andersson G, Christensen H, Meyer B, Huibers M, Smit F, van Straten A, Warmerdam L, Barkham M, Bilich L, Lovell K, Liu ETH. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. BMJ 2013; 346:f540. [PMID: 23444423 PMCID: PMC3582703 DOI: 10.1136/bmj.f540] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression. DESIGN Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care. SETTING Primary care and community settings. PARTICIPANTS 2470 patients with depression. INTERVENTIONS Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions). MAIN OUTCOME MEASURES Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions. RESULTS Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant. CONCLUSIONS The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.
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Affiliation(s)
- Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK.
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Collaborative research: a case example of dissemination of CBT in primary care. COGNITIVE BEHAVIOUR THERAPIST 2013. [DOI: 10.1017/s1754470x13000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWhile we now have a strong evidence base for cognitive behaviour therapy in managing mental health problems, the challenge is to disseminate it into real-world settings. Two dissemination approaches exist: the dominant ‘research to practice’ model, a linear sequence, taking interventions from the research laboratory and overcoming barriers so as to apply them in the real world and a more collaborative approach, in which researchers work together with clinicians and patients to adapt existing treatments for real-world settings. This article provides a detailed example of a collaborative approach to adapting cognitive behaviour therapy, by developing a very brief mental health intervention for patients in a primary-care (family doctor) setting.
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Moldovan R, Cobeanu O, David D. Cognitive Bibliotherapy for Mild Depressive Symptomatology: Randomized Clinical Trial of Efficacy and Mechanisms of Change. Clin Psychol Psychother 2012; 20:482-93. [DOI: 10.1002/cpp.1814] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Ramona Moldovan
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Oana Cobeanu
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Daniel David
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
- Mount Sinai School of Medicine; Oncological Sciences Department; New York USA
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22
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Haug T, Nordgreen T, Öst LG, Havik OE. Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators. Clin Psychol Rev 2012; 32:425-45. [DOI: 10.1016/j.cpr.2012.04.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 04/11/2012] [Accepted: 04/11/2012] [Indexed: 11/24/2022]
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Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychol Med 2011; 41:2239-2252. [PMID: 21672297 DOI: 10.1017/s0033291711000900] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically. METHOD A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted. RESULTS Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals. CONCLUSIONS Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression.
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Affiliation(s)
- G Coull
- Clinical and Health Psychology, University of Edinburgh, UK.
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24
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Høifødt RS, Strøm C, Kolstrup N, Eisemann M, Waterloo K. Effectiveness of cognitive behavioural therapy in primary health care: a review. Fam Pract 2011; 28:489-504. [PMID: 21555339 DOI: 10.1093/fampra/cmr017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent disorders causing substantial impairment in daily life. Cognitive behavioural therapy (CBT) delivered face-to-face or as self-help has shown to be an effective treatment for these disorders. Such treatments may be suitable for delivery in primary health care. AIM The aim of the article was to review research on the effectiveness of CBT for depression and anxiety disorders delivered in primary care by primary care therapists. METHODS A literature search of quantitative studies of the effectiveness of CBT delivered in primary care was conducted on multiple electronic databases. A total of 17 studies were included in the review. RESULTS Eight studies of supported Internet- or computer-based CBT, six of which were randomized controlled trials (RCTs), indicate that this treatment is effective for mild to moderate depression and anxiety. Five studies suggest that this treatment may be more effective than usual care for mild to moderate but not for more severe symptoms. Results of four RCTs of brief therapies using written self-help material suggest that while such interventions are effective, no particular approach outperformed any other, including usual care. Five RCTs of CBT delivered face-to-face show that this treatment can be effective when delivered by therapists highly educated in the mental health field. However, many primary care therapists may find such interventions too time consuming. CONCLUSIONS CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.
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Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P. Effectiveness of guided self-help for depression and anxiety disorders in primary care: a pragmatic randomized controlled trial. Psychiatry Res 2011; 187:113-20. [PMID: 21145112 DOI: 10.1016/j.psychres.2010.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 11/02/2010] [Accepted: 11/11/2010] [Indexed: 11/16/2022]
Abstract
The objective of this study is to evaluate the effectiveness of (guided) self-help in primary care for patients diagnosed with a minor or major mood and/or anxiety disorder. The study population consists of 120 (screened) primary care patients aged 18-65 years with at least one mood and/or anxiety disorder. The primary focus is the reduction of depressive and anxiety symptoms. The self-help courses (Problem Solving Treatment and exposure) took 6 weeks to complete. The self-help group reported slightly better outcomes than the care-as-usual group but these results were not significant: d=-0.18 (95% CI=-2.29 to 7.31) for symptoms of depression and d=-0.20 (95% CI=-0.74 to 2.29) for symptoms of anxiety. For patients with an anxiety disorder only, the anxiety symptoms decreased significantly compared to the care-as-usual group (d=-0.68; 95% CI=0.25 to 4.77). Self-help seems only slightly superior to care-as-usual and therefore might not be an effective tool in general practice. But the lack of results could also be due to our selection of patients or to our selection of GPs (with interest in psychiatric disorders). Nonetheless the promising signals with respect to anxiety disorders warrant further research.
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Affiliation(s)
- Wike Seekles
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
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McKenna G, Hevey D, Martin E. Patients' and providers' perspectives on bibliotherapy in primary care. Clin Psychol Psychother 2011; 17:497-509. [PMID: 20146202 DOI: 10.1002/cpp.679] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered.
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Affiliation(s)
- Grainne McKenna
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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Lucock M, Kirby R, Wainwright N. A pragmatic randomized controlled trial of a guided self-help intervention versus a waiting list control in a routine primary care mental health service. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 50:298-309. [DOI: 10.1348/014466510x520231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Webber M, Huxley P, Harris T. Social capital and the course of depression: six-month prospective cohort study. J Affect Disord 2011; 129:149-57. [PMID: 20817266 DOI: 10.1016/j.jad.2010.08.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 08/09/2010] [Accepted: 08/10/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous research has found an inverse cross-sectional relationship between an individual's access to social capital (defined as resources embedded within social networks) and depression, but this relationship has not been rigorously tested in prospective research. This is the first longitudinal study to evaluate the effect of social capital on the course of depression and subjective quality of life in a clinical population. METHODS This was a six-month prospective cohort study of people with depression in primary care achieving a follow-up rate of 91.3% (n=158). Depression was measured with the HAD-D and social capital using the Resource Generator-UK. Potential confounding variables including socio-demographics, socio-economic status, depression history, social support, life events and attachment style were also measured. RESULTS Social capital had no independent effect on the course of depression, though an interaction of access to social capital and attachment style was significantly related to change in quality of life alongside multiple covariates. LIMITATIONS The study used a small sample; a short follow-up period; no measure of ecological social capital; no genetic components; and only two time points. CONCLUSIONS Emotional support is important for the alleviation of depression. Additionally, people with depression may require a secure attachment style to derive the full benefit of their social capital.
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Affiliation(s)
- Martin Webber
- King's College London, Institute of Psychiatry, United Kingdom.
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29
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Affiliation(s)
- Yong Chon Park
- Department of Neuropsychiatry, Hanyang University College of Medicine, Seoul, Korea
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30
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Traviss GD, Heywood-Everett S, Hill AJ. Guided self-help for disordered eating: A randomised control trial. Behav Res Ther 2011; 49:25-31. [DOI: 10.1016/j.brat.2010.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 10/06/2010] [Accepted: 10/27/2010] [Indexed: 11/30/2022]
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31
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You can’t get anything perfect: “User perspectives on the delivery of cognitive behavioural therapy by telephone”. Soc Sci Med 2010; 71:1308-1315. [DOI: 10.1016/j.socscimed.2010.06.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 06/15/2010] [Accepted: 06/27/2010] [Indexed: 11/18/2022]
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Zinken J, Zinken K, Wilson JC, Butler L, Skinner T. Analysis of syntax and word use to predict successful participation in guided self-help for anxiety and depression. Psychiatry Res 2010; 179:181-6. [PMID: 20483481 DOI: 10.1016/j.psychres.2010.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 03/05/2010] [Accepted: 04/11/2010] [Indexed: 11/18/2022]
Abstract
This study investigated whether an analysis of narrative style (word use and cross-clausal syntax) of patients with symptoms of generalised anxiety and depression disorders can help predict the likelihood of successful participation in guided self-help. Texts by 97 people who had made contact with a primary care mental health service were analysed. Outcome measures were completion of the guided self-help programme, and change in symptoms assessed by a standardised scale (CORE-OM). Regression analyses indicated that some aspects of participants' syntax helped to predict completion of the programme, and that aspects of syntax and word use helped to predict improvement of symptoms. Participants using non-finite complement clauses with above-average frequency were four times more likely to complete the programme (95% confidence interval 1.4 to 11.7) than other participants. Among those who completed, the use of causation words and complex syntax (adverbial clauses) predicted improvement, accounting for 50% of the variation in well-being benefit. These results suggest that the analysis of narrative style can provide useful information for assessing the likelihood of success of individuals participating in a mental health guided self-help programme.
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Affiliation(s)
- Jörg Zinken
- Department of Psychology, University of Portsmouth, Portsmouth PO1 2DY, UK.
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Warrilow AE, Beech B. Self-help CBT for depression: opportunities for primary care mental health nurses? J Psychiatr Ment Health Nurs 2009; 16:792-803. [PMID: 19824973 DOI: 10.1111/j.1365-2850.2009.01457.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mental health treatments that are effective and accessible to the general population are in high demand. Cognitive behavioural therapy (CBT) has been shown to be effective and is popular but such treatments are difficult to access especially within primary care, causing delay, frustration and suffering. One approach to meeting demand would be through the use of self-help CBT materials that aim to address common mental health problems such as depression. The aim of this review is to discover whether self-help CBT materials are effective in the treatment of depression and how mental health nurses within primary care can use their skills to provide access and low-level support. Studies critiqued within this literature review indicate that self-help CBT is effective for the treatment of depression. However, there is a lack of evidence that specifically considers self-help CBT for the treatment of depression in primary care. This review addresses the question of how much nurse client contact is needed to provide adequate support for the facilitation of self-help CBT in depression with primary care patients and recommends the use of a service delivery model. However, more research needs to be carried out on the application of self-help CBT for depression in primary care.
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Affiliation(s)
- A E Warrilow
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, Staffs, UK
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Richardson R, Richards DA, Barkham M. Self-help books for people with depression: A scoping review. J Ment Health 2009. [DOI: 10.1080/09638230802053334] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pilgrim D, Rogers A, Bentall R. The centrality of personal relationships in the creation and amelioration of mental health problems: the current interdisciplinary case. Health (London) 2009; 13:235-54. [PMID: 19228830 DOI: 10.1177/1363459308099686] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An interdisciplinary case is made for the centrality of personal relationships in the creation and amelioration of mental health problems. Taking the work of John Bowlby as a starting point, the article summarizes accumulating evidence from the past 50 years about the link between childhood adversity and adult mental health problems. Evidence is also reviewed about contemporary interpersonal impacts on adult mental health from natural social settings and in professional therapy. These empirical summaries are then discussed in the context of dominant trends in professional knowledge about bio-determinism within psychiatry and the emphasis upon models and techniques in professional and political advocates of the psychological therapies. It is concluded that the latter trends are diverting us from policies, which properly concede the importance of relationships for improving the mental health of the population.
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Bilich LL, Deane FP, Phipps AB, Barisic M, Gould G. Effectiveness of bibliotherapy self-help for depression with varying levels of telephone helpline support. Clin Psychol Psychother 2009; 15:61-74. [PMID: 19115429 DOI: 10.1002/cpp.562] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effectiveness of a cognitive behavioural bibliotherapy self-help package, with varied levels of telephone support, delivered through a mental health telephone service was examined with 84 mildly to moderately depressed adults. The study compared the changes in depressive symptoms of three groups: control, self help with minimal contact and self-help with telephone assistance. Both the minimal contact and the assisted self-help groups had significant reductions in their levels of depression compared with the control group. Treatment gains were maintained at a 1-month follow-up. The potential of self-help resources such as this to be successfully disseminated and delivered through a national mental health telephone information service is discussed.
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Lovell K, Bower P, Richards D, Barkham M, Sibbald B, Roberts C, Davies L, Rogers A, Gellatly J, Hennessy S. Developing guided self-help for depression using the Medical Research Council complex interventions framework: a description of the modelling phase and results of an exploratory randomised controlled trial. BMC Psychiatry 2008; 8:91. [PMID: 19025646 PMCID: PMC2596776 DOI: 10.1186/1471-244x-8-91] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 11/24/2008] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Current guidelines for the management of depression suggest the use of guided self-help for patients with mild to moderate disorders. However, there is little consensus concerning the optimal form and delivery of this intervention. To develop acceptable and effective interventions, a phased process has been proposed, using a modelling phase to examine and develop an intervention prior to preliminary testing in an exploratory trial. This paper (a) describes the modelling phase used to develop a guided self-help intervention for depression in primary care and (b) reports data from an exploratory randomised trial of the intervention. METHODS A guided self-help intervention was developed following a modelling phase which involved a systematic review, meta synthesis and a consensus process. The intervention was then tested in an exploratory randomised controlled trial by examining (a) fidelity using analysis of taped guided self-help sessions (b) acceptability to patients and professionals through qualitative interviews (c) effectiveness through estimation of the intervention effect size. RESULTS Fifty eight patients were recruited to the exploratory trial. Seven professionals and nine patients were interviewed, and 22 tapes of sessions analysed for fidelity. Generally, fidelity to the intervention protocol was high, and the professionals delivered the majority of the specific components (with the exception of the use of feedback). Acceptability to both professionals and patients was also high. The effect size of the intervention on outcomes was small, and in line with previous analyses showing the modest effect of guided self-help in primary care. However, the sample size was small and confidence intervals around the effectiveness estimate were wide. CONCLUSION The general principles of the modelling phase adopted in this study are designed to draw on a range of evidence, potentially providing an intervention that is evidence-based, patient-centred and acceptable to professionals. However, the pilot outcome data did not suggest that the intervention developed was particularly effective. The advantages and disadvantages of the general methods used in the modelling phase are discussed, and possible reasons for the failure to demonstrate a larger effect in this particular case are outlined.
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Affiliation(s)
- Karina Lovell
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK.
| | - Peter Bower
- National Primary Care Research & Development Centre, The University of Manchester, Manchester, UK
| | | | - Michael Barkham
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Bonnie Sibbald
- National Primary Care Research & Development Centre, The University of Manchester, Manchester, UK
| | - Chris Roberts
- School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - Linda Davies
- School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - Anne Rogers
- School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - Judith Gellatly
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Sue Hennessy
- Department of Health Sciences, University of York, York, UK
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Controlled Clinical Trial of a Self-Help for Anxiety Intervention for Patients Waiting for Psychological Therapy. Behav Cogn Psychother 2008. [DOI: 10.1017/s1352465808004591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 2008; 22:343-96. [PMID: 18413657 DOI: 10.1177/0269881107088441] [Citation(s) in RCA: 335] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
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Affiliation(s)
- I M Anderson
- Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK.
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Smolders M, Laurant M, Roberge P, van Balkom A, van Rijswijk E, Bower P, Grol R. Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:277-93. [PMID: 18551849 DOI: 10.1177/070674370805300502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To summarize current evidence on the effectiveness of different knowledge transfer and change interventions for improving primary and ambulatory anxiety care to provide guidance to professionals and policy-makers in mental health care. METHOD We searched electronic medical and psychological databases, conducted correspondence with authors, and checked reference lists. Studies examining the effectiveness of knowledge transfer and interventions targeted at improvement of the recognition or management of anxiety in primary and ambulatory health care settings were included. Methodological details and outcomes were independently extracted and checked by 2 reviewers. Where appropriate, data concerning the impact of interventions on symptoms of anxiety were pooled using metaanalytical procedures. RESULTS We identified 24 studies that met our inclusion criteria. Seven professional-directed interventions and 17 organizational interventions (including patient-oriented interventions) were identified. The methodological quality of studies was variable. Professional-directed interventions only impact the process and outcome of care when embedded in some sort of organizational intervention. Metaanalysis (n = 8 studies) showed no effect of diverse organizational interventions on patients' anxiety symptoms (effect size, -0.08; 95% confidence interval, -0.31 to 0.15; P = 0.50). Collaborative care interventions proved to be the most effective organizational intervention strategies. Six studies reported economic results: 4 studies showed that intervention had a high probability of being cost-effective. CONCLUSIONS Collaborative care seems to be very promising for improving primary and ambulatory care for anxiety. At the level of management and policy, the results of this review mandate the need to offer fair and reasonable reimbursement for collaborative care programs.
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Affiliation(s)
- Mirrian Smolders
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Chamberlain D, Heaps D, Robert I. Bibliotherapy and information prescriptions: a summary of the published evidence-base and recommendations from past and ongoing Books on Prescription projects. J Psychiatr Ment Health Nurs 2008; 15:24-36. [PMID: 18186826 DOI: 10.1111/j.1365-2850.2007.01201.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper summarizes the published evidence and reports from ongoing and completed projects that used Bibliotherapy and Information Prescription to deliver patient care. A literature search was conducted and relevant papers were summarized into: type of study, type of Bibliotherapy, client group and recommendations. In total, 65 papers were considered with 57 reviewed. A survey was also sent to Library Authorities subscribing to national survey standards asking for details about delivery of Information Prescription projects. There were 21 returned surveys. The experiences and recommendations were then summarized. The aim of the paper is to collate the evidence-base of written research and the experience and recommendations of projects into an easy format so that practitioners interested in using Bibliotherapy/Information Prescription/Books on Prescription have an understanding what they are, the extent of the evidence-base to inform practice, and highlight gaps in the research.
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Affiliation(s)
- D Chamberlain
- Community Outreach, Worcestershire Health Libraries, Alexandra Hospital, Redditch, UK.
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Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K. What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med 2007; 37:1217-1228. [PMID: 17306044 DOI: 10.1017/s0033291707000062] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although self-help interventions are effective in treating depression, less is known about the factors that determine effectiveness (i.e. moderators of effect). This study sought to determine whether the content of self-help interventions, the study populations or aspects of study design were the most important moderators. METHOD Randomized trials of the effectiveness of self-help interventions versus controls in the treatment of depressive symptoms were identified using previous reviews and electronic database searches. Data on moderators (i.e. patient populations, study design, intervention content) and outcomes were extracted and analysed using meta-regression. RESULTS Thirty-four studies were identified with 39 comparisons. Study design factors associated with greater effectiveness were unclear allocation concealment, observer-rated outcome measures and waiting-list control groups. Greater effectiveness was also associated with recruitment in non-clinical settings, patients with existing depression (rather than those 'at risk'), contact with a therapist (i.e. guided self-help) and the use of cognitive behavioural therapy (CBT) techniques. However, only guided self-help remained significant in the multivariate analysis [regression coefficient 0.36, 95% confidence interval (CI) 0.05-0.68, p=0.03]. In the subset of guided studies, there were no significant associations between outcomes and the session length, content, delivery mode or therapist background. CONCLUSIONS The results provide some insights into moderators of self-help interventions, which might assist in the design of future interventions. However, the present study did not provide a comprehensive description, and other research methods might be required to identify factors associated with the effectiveness of self-help.
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Affiliation(s)
- Judith Gellatly
- Department of Nursing, Midwifery and Health Visiting, University of Manchester, UK
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Khan N, Bower P, Rogers A. Guided self-help in primary care mental health: meta-synthesis of qualitative studies of patient experience. Br J Psychiatry 2007; 191:206-11. [PMID: 17766759 DOI: 10.1192/bjp.bp.106.032011] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a gap between the supply of trained cognitive-behavioural therapists to treat depression and demand for care in the community. There is interest in the potential of self-help interventions, which require less input from a therapist. However, the design of effective self-help interventions is complex. Qualitative research can help to explore some of this complexity. AIMS The study aimed to identify qualitative studies of patient experience of depression management in primary care, synthesise these studies to develop an explanatory framework, and then apply this framework to the development of a guided self-help intervention for depression. METHOD A meta-synthesis was conducted of published qualitative research. RESULTS The synthesis revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions. CONCLUSIONS This meta-synthesis of qualitative studies provided a useful explanatory framework for the development of effective and acceptable guided self-help interventions for depression.
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Affiliation(s)
- Nagina Khan
- National Primary Care Research and Development Centre, 5th Floor Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Abstract
A growing body of evidence supports the efficacy of computerized cognitive behavioural therapy (CCBT). This technology has the potential to increase the capacity of mental health services, and to overcome some of the barriers to accessing mental health services, including stigma, traveling time for rural patients, treatment delays, and the low availability of skilled clinicians. This review discusses key issues around the implementation of CCBT in current mental health services, and summarizes recent evidence for the efficacy of CCBT in anxiety and depression. Many CCBT systems exist, and the evidence for each varies in quality and quantity. It is concluded that CCBT, particularly guided by a therapist, represents a promising resource. However, considerable work needs to be done to develop CCBT techniques that are appropriate to Australasian populations, acceptable to patients and clinicians, easy to use, and are clinically and cost effective. Suggestions are made for further research and useful website addresses are provided to assist clinicians in familiarizing themselves with CCBT.
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Affiliation(s)
- Nickolai Titov
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
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Macdonald W, Mead N, Bower P, Richards D, Lovell K. A qualitative study of patients' perceptions of a 'minimal' psychological therapy. Int J Soc Psychiatry 2007; 53:23-35. [PMID: 17333949 DOI: 10.1177/0020764006066841] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Access to psychological therapy is often difficult. Problems with access may be overcome through 'minimal interventions' (such as books and computer programs), which encourage self-help for mental health problems and are less dependent on the availability of specialist therapists. However, to be effective, such interventions must be acceptable to patients. AIMS To use qualitative methods to explore patient attitudes, by examining patient expectancies of psychological therapy and their experiences with a 'minimal intervention' (guided self-help). METHODS Qualitative interviews (N = 24) were conducted with patients after they had received guided self-help for depression as part of a randomised controlled trial. RESULTS There were important gaps between patients' expectancies of psychological therapy and their experience of the guided self-help. These gaps related to the process of therapy (e.g. time, professional expertise) and outcomes. Particularly salient was a theme relating to explanatory models. Patients were often seeking insight into the 'cause' of their current difficulties, whereas the minimal intervention was largely focused on symptom resolution. CONCLUSIONS The effective implementation of 'minimal interventions' requires an understanding of the expectancies of patients concerning psychological therapy, in order to provide a basis for effective communication and negotiation between professionals and patients.
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Affiliation(s)
- Wendy Macdonald
- National Primary Care Research and Development Centre, University of Manchester, UK.
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Ekers DM, Lovell K, Playle JF. The use of CBT based, brief, facilitated self-help interventions in primary care mental health service provision: Evaluation of a 10-day training programme. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cein.2006.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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