Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial - PubMed (original) (raw)

Randomized Controlled Trial

Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial

Christopher Williams et al. PLoS One. 2013.

Erratum in

Abstract

Background: Access to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU).

Hypotheses: GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff.

Participants: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU.

Interventions: RCT comparing 'Overcoming Depression: A Five Areas Approach' book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU.

Primary outcome: The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months.

Outcome: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change).

Limitations: Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%). In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment.

Conclusions: GSH-CBT is substantially more effective than TAU.

Trial registration: Controlled-Trials.com ISRCTN13475030.

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Conflict of interest statement

Competing Interests: CW is author of the self-help book evaluated in this study (Overcoming depression and low mood: a five areas approach) and has authored another self-help book addressing depression (Why Do I feel so bad) and is principle author of the free access www.llttf.com website which addresses depression and low mood. CW is also Director and shareholder of Five Areas Limited which markets online and written self-help resources and training. His wife is company secretary of Five Areas Limited and holds shares in it. CW has advised on various Government and National Health Service advisory bodies in the area of mental health (Scottish Government Health Department committees on Training, Integrated Care Pathway for Depression Development Group, Doing Well By People with Depression Steering Group, Towards a Mentally Flourishing Scotland, Psychological Therapies Committee, Alternative Delivery Mechanisms, Eating disorders. Also English Department of Health: New Technologies Group member). He is also Patron of two user groups (Anxiety United Kingdom and Triumph over Phobia). The other authors declare no competing interests exist. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

References

    1. National Institute for Clinical Excellence (2009) Partial update of CG23: Depression: management of depression in primary and secondary care. London (http://guidance.nice.org.uk/CG/WaveR/24)
    1. Anderson L, Lewis G, Araya R, Elgin R, Harrison G, et al. (2005) Self-help books for depression: How can practitioners and patients make the right choice? Br J Gen Pract 55 (514) 387–92. -PMC -PubMed
    1. Jorm AF (2000) Mental Health Literacy: public knowledge and beliefs about mental disorders. Br J Psychiatry 177: 396–401. -PubMed
    1. Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, et al. (2007) What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med 37 (9) 1217–28. -PubMed
    1. Williams CJ (2001) Overcoming depression: A Five Areas Approach. London: England: Hodder Arnold.

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