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 (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. 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 (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%. 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.
RCT Entities:
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 (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. 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 (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%. 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.
Entities:
Keywords:
Adjustment Disorder; Anxiety; CBT; Common Mental Disorders; Depression; Exhaustion Disorder; Face-to-Face CBT; Guided Self-Help; Insomnia; Primary Care; Stepped care
Authors: Saira A Weinzimmer; Amy R Goetz; Andrew G Guzick; Lynn M Hana; Sandra L Cepeda; Sophie C Schneider; Sarah M Kennedy; Gifty N Amos Nwankwo; Catherine C Christian; Ashley M Shaw; Alison Salloum; Asim A Shah; Wayne K Goodman; Jill Ehrenreich-May; Eric A Storch Journal: Community Ment Health J Date: 2022-04-04
Authors: Kai Spiegelhalder; Harald Baumeister; Dieter Riemann; David Daniel Ebert; Abdulwahab Al-Kamaly; Martina Bader; Natalie Bauereiss; Fee Benz; Lina Braun; Claudia Buntrock; Maike Burkhardt; Pim Cuijpers; Katharina Domschke; Patrick Dülsen; Marvin Franke; Lukas Frase; Elena Heber; Kathrin Helm; Terry Jentsch; Anna Johann; Ann-Marie Küchler; Michael Kuhn; Dirk Lehr; Andy Maun; Charles M Morin; Morten Moshagen; Kneginja Richter; Julian Schiel; Laura Simon; Lukas Spille; Hans-Günter Weeß Journal: BMJ Open Date: 2022-08-03 Impact factor: 3.006
Authors: Roberto Mediavilla; Kerry R McGreevy; Mireia Felez-Nobrega; Anna Monistrol-Mula; María-Fe Bravo-Ortiz; Carmen Bayón; Beatriz Rodríguez-Vega; Pablo Nicaise; Audrey Delaire; Marit Sijbrandij; Anke B Witteveen; Marianna Purgato; Corrado Barbui; Federico Tedeschi; Maria Melchior; Judith van der Waerden; David McDaid; A-La Park; Raffael Kalisch; Papoula Petri-Romão; James Underhill; Richard A Bryant; Josep Maria Haro; José Luis Ayuso-Mateos Journal: Digit Health Date: 2022-10-05
Authors: Manuela Silva; Ana Antunes; Sofia Azeredo-Lopes; Graça Cardoso; Miguel Xavier; Benedetto Saraceno; José Miguel Caldas-de-Almeida Journal: BMC Psychiatry Date: 2020-05-11 Impact factor: 3.630