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

Christopher Williams, Philip Wilson, Jill Morrison, Alex McMahon, Andrew Walker, Lesley Allan, Alex McConnachie, Yvonne McNeill, Louise Tansey

Research output: Contribution to journalArticle

34 Citations (Scopus)
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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 TAU
Guided self-help will be acceptable to patients and staff.
Methods and Findings

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
Original languageEnglish
Article numbere52735
Number of pages7
JournalPloS ONE
Volume8
Issue number1
DOIs
Publication statusPublished - 11 Jan 2013

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Cognitive Therapy
Deterioration
Primary Health Care
emotions
Randomized Controlled Trials
Depression
therapeutics
general practitioners
Therapeutics
adverse effects
deterioration
General Practice
General Practitioners
Appointments and Schedules
methodology

Cite this

Guided self-help cognitive behavioural therapy for depression in primary care : a randomised controlled trial. / Williams, Christopher; Wilson, Philip; Morrison, Jill; McMahon, Alex; Walker, Andrew; Allan, Lesley; McConnachie, Alex; McNeill, Yvonne; Tansey, Louise.

In: PloS ONE, Vol. 8, No. 1, e52735, 11.01.2013.

Research output: Contribution to journalArticle

Williams, C, Wilson, P, Morrison, J, McMahon, A, Walker, A, Allan, L, McConnachie, A, McNeill, Y & Tansey, L 2013, 'Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial', PloS ONE, vol. 8, no. 1, e52735. https://doi.org/10.1371/journal.pone.0052735
Williams, Christopher ; Wilson, Philip ; Morrison, Jill ; McMahon, Alex ; Walker, Andrew ; Allan, Lesley ; McConnachie, Alex ; McNeill, Yvonne ; Tansey, Louise. / Guided self-help cognitive behavioural therapy for depression in primary care : a randomised controlled trial. In: PloS ONE. 2013 ; Vol. 8, No. 1.
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T1 - Guided self-help cognitive behavioural therapy for depression in primary care

T2 - a randomised controlled trial

AU - Williams, Christopher

AU - Wilson, Philip

AU - Morrison, Jill

AU - McMahon, Alex

AU - Walker, Andrew

AU - Allan, Lesley

AU - McConnachie, Alex

AU - McNeill, Yvonne

AU - Tansey, Louise

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N2 - BackgroundAccess 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.Methods and FindingsParticipants: 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).LimitationsWeaknesses: 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.ConclusionsGSH-CBT is substantially more effective than TAU.Trial RegistrationControlled-Trials.com ISRCTN13475030

AB - BackgroundAccess 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.Methods and FindingsParticipants: 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).LimitationsWeaknesses: 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.ConclusionsGSH-CBT is substantially more effective than TAU.Trial RegistrationControlled-Trials.com ISRCTN13475030

U2 - 10.1371/journal.pone.0052735

DO - 10.1371/journal.pone.0052735

M3 - Article

VL - 8

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

IS - 1

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ER -