Treating Depression And Anxiety In The Primary Care Setting

AbstractThe feasibility and effectiveness of trainee psychiatrists providing CBT in primary care was assessed by a triangulated procedure of service overview, trainee feedback and assessment of clinical measures. Hitherto trainees sought ‘suitable’ cases by individual request. In the primary-care setting: 82% of 11 trainees (50% previously) completed a ‘short case’ treatment within a 6-month attachment; 86% of trainees found the level of supervision ‘about right’; depression and anxiety scores for patients (n = 16) achieved statistically significant gains and showed moderate to large effect sizes. Although there was no comparator group, findings were just above the IAPT aim of a 50% recovery. Conclusions are that completion of their ‘short case’ experience within a 6-month attachment is feasible in a primary-care setting. Evidence that patients and the service also benefited demonstrates this to be good and ethical ‘business’ for the service provider. Integrating these skills into routine medical psychiatric practice may remain a later supervision need. Other training experiences including psychological treatments could initially be best met in less testing clinical encounters than those experienced in secondary care. Locally agreed formal arrangements would facilitate this and there is potential for the development of greater cross-service understanding in the longer term.

Download Full-text

Investigating Effectiveness and Predicting Outcome and Dropout From Systems Training for Emotional Predictability and Problem Solving for Emotional Intensity Difficulties (STEPPS EI) in UK Primary Care

Journal of Personality Disorders ◽

10.1521/pedi_2021_35_519 ◽

2021 ◽

pp. 1-15

Author(s):

Ivana Hezelyova ◽

Hannah Cribben ◽

Natasha Melunsky ◽

Shumona Moalypour ◽

Huw Goodwin ◽

...

Keyword(s):

Primary Care ◽

Problem Solving ◽

Group Treatment ◽

Care Setting ◽

Primary Care Setting ◽

Symptom Improvement ◽

Emotional Intensity ◽

Depression And Anxiety ◽

Predicting Outcome ◽

Dropout Predictors

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder (BPD) has been adapted for a primary care setting into a 13-week group treatment for emotional intensity difficulties (STEPPS EI). This is the first study to examine the effectiveness and potential outcome and dropout predictors of STEPPS EI in a primary care setting. Severity of BPD, depression, and anxiety symptoms were measured pre- and postintervention for 148 participants. Treatment completers showed improvements in depression, anxiety, and BPD symptoms with medium to large effect sizes. A predictor of symptom improvement was higher baseline severity for each of the symptom measures. Attending a psychoeducational group prior to STEPPS EI was associated with lower odds of dropout. The findings support the use of STEPPS EI in a primary care setting, with the potential to alleviate the burden from other local services.

Download Full-text