Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

2017 ◽  
Vol 48 (10) ◽  
pp. 1644-1654 ◽  
Author(s):  
Sigrid Salomonsson ◽  
Fredrik Santoft ◽  
Elin Lindsäter ◽  
Kersti Ejeby ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Stepped Care ◽  
Care Model ◽  
Face To Face ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Remission Rates

AbstractBackgroundCommon mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.MethodsConsecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.ResultsAfter GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.ConclusionsStepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

scholarly journals Predictors of outcome in guided self-help cognitive behavioural therapy for common mental disorders in primary care

2019 ◽  
Vol 49 (6) ◽  
pp. 455-474
Author(s):  
Sigrid Salomonsson ◽  
Fredrik Santoft ◽  
Elin Lindsäter ◽  
Kersti Ejeby ◽  
Martin Ingvar ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Cognitive Behavioural Therapy ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Predictors Of Outcome ◽  
Self Help ◽  
Cognitive Behavioural

scholarly journals Guided self-help in a brave new world

2018 ◽  
Vol 212 (2) ◽  
pp. 65-66 ◽  
Author(s):  
Jaime Delgadillo
Keyword(s):  
Mental Disorders ◽  
Cognitive Behavioural Therapy ◽  
New World ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Evidence Based ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Brave New World

SummaryCognitive–behavioural therapy self-help offers an accessible and efficient way to treat common mental disorders. The evidence-based self-help movement has an important foothold in the healthcare arena. This article surveys the emergence of self-help at a particular social and historical junction, and summarises key lessons from experimental and practice-based studies.Declaration of interestNone.

scholarly journals Stepped care and cognitive–behavioural therapy for bulimia nervosa: randomised trial

2011 ◽  
Vol 198 (5) ◽  
pp. 391-397 ◽  
Author(s):  
James E. Mitchell ◽  
Stewart Agras ◽  
Scott Crow ◽  
Katherine Halmi ◽  
Christopher G. Fairburn ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Cognitive Behavioural Therapy ◽  
Relative Effectiveness ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Individual Therapy ◽  
Stepped Care ◽  
Self Help ◽  
Treatment Conditions ◽  
Cognitive Behavioural

BackgroundThis study compared the best available treatment for bulimia nervosa, cognitive–behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness.AimsTo establish the relative effectiveness of these two approaches.MethodThis was a randomised trial conducted at four clinical centres (Clinicaltrials.gov registration number: NCT00733525). A total of 293 participants with bulimia nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management.ResultsBoth in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM–IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT.ConclusionsTherapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach.

scholarly journals Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months

2011 ◽  
Vol 199 (6) ◽  
pp. 459-466 ◽  
Author(s):  
Vikram Patel ◽  
Helen A. Weiss ◽  
Neerja Chowdhary ◽  
Smita Naik ◽  
Sulochana Pednekar ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Suicidal Behaviour ◽  
Common Mental Disorders ◽  
Stepped Care ◽  
Psychological Morbidity ◽  
Public Facilities ◽  
Care Facilities ◽  
Icd 10

BackgroundDepressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.AimsTo test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.MethodTwenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407).ResultsA total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.ConclusionsTrained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.

scholarly journals Psychological approaches to somatisation in developing countries

2006 ◽  
Vol 12 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Vikram Patel ◽  
Athula Sumathipala
Keyword(s):  
Primary Care ◽  
Developing Countries ◽  
Somatoform Disorders ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Clinical Presentations ◽  
Proven Efficacy ◽  
Medically Unexplained ◽  
Main Components

Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are a considerable burden for patients and the healthcare system. They are assumed to be the result of psychosocial factors, and the process by which symptoms are experienced is termed somatisation. Common mental disorders, somatoform disorders and socio-economic adversities are the major risk factors for these complaints. There is evidence suggesting that cognitive–behavioural therapy, which has proven efficacy for somatoform disorders in the developed world, can be used in developing countries with some adaptations (e.g. by simplifying the content so that it can be applied in primary care by non-specialist health practitioners; using culturally appropriate analogies; and delivering the intervention over fewer and shorter sessions). The main components of such an intervention are presented in this article.

scholarly journals Guided Self-Help Cognitive Behavioural Therapy for Depression in Primary Care: A Randomised Controlled Trial

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e52735 ◽  
Author(s):  
Christopher Williams ◽  
Philip Wilson ◽  
Jill Morrison ◽  
Alex McMahon ◽  
Walker Andrew ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Randomised Controlled

scholarly journals The evidence base for cognitive—behavioural therapy in depression: delivery in busy clinical settings

2003 ◽  
Vol 9 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Graeme Whitfield ◽  
Chris Williams
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Clinical Settings ◽  
Face To Face ◽  
Psychological Therapies ◽  
Department Of Health ◽  
Self Help ◽  
Cognitive Behavioural

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review documentTreatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

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