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

Williams, C. , Wilson, P., Morrison, J. , McMahon, A. , Walker, A., Allan, L., McConnachie, A. , McNeill, Y. and Tansey, L. (2013) Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial. PLoS ONE, 8(1), e52735. (doi: 10.1371/journal.pone.0052735) (PMID:23326352) (PMCID:PMC3543408)

Abstract

<br>Background: Access to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books.</br> <br>Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU).</br> <br>Hypotheses:</br> <br>1. GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAU</br> <br>2. Guided self-help will be acceptable to patients and staff.</br> <br>Methods and Findings</br> <br>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.</br> <br>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.</br> <br>Primary outcome: The BDI (II) score at 4 months.</br> <br>Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months.</br> <br>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.</br> <br>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).</br> <br>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.</br> <br>Conclusions: GSH-CBT is substantially more effective than TAU.</br>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Allan, Miss Lesley and Morrison, Professor Jill and Williams, Professor Christopher and McConnachie, Professor Alex and Walker, Dr Andrew and Wilson, Prof Philip and McMahon, Dr Alex
• Authors: Williams, C., Wilson, P., Morrison, J., McMahon, A., Walker, A., Allan, L., McConnachie, A., McNeill, Y., and Tansey, L.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• Published Online: 01 January 2013
• Copyright Holders: Copyright © 2013 The Authors
• First Published: First published in PloS ONE 8(1):e52735
• Publisher Policy: Reproduced under a Creative Commons License