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

Authors :
Salomonsson, Sigrid
Santoft, Fredrik
Lindsäter, Elin
Ejeby, Kersti
Ljótsson, Brjánn
Öst, Lars-Göran
Ingvar, Martin
Lekander, Mats
Hedman-Lagerlöf, Erik
Source :
Psychological Medicine. Aug2018, Vol. 48 Issue 10, p1644-1654. 11p.
Publication Year :
2018

Abstract

Background: Common 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. Methods: Consecutive patients (<italic>N</italic> = 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. Results: After 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 (<italic>p</italic> = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. Conclusions: Stepped 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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00332917
Volume :
48
Issue :
10
Database :
Academic Search Index
Journal :
Psychological Medicine
Publication Type :
Academic Journal
Accession number :
130116990
Full Text :
https://doi.org/10.1017/S0033291717003129