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

Abstract

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).HypothesesGSH-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 findingsParticipantsAdults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU.InterventionsRCT 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 outcomeThe BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months.OutcomeMean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, pLimitationsWeaknesses: 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.