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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
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2018 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, no 10, p. 1644-1654Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2018. Vol. 48, no 10, p. 1644-1654
Keywords [en]
Adjustment Disorder, Anxiety, CBT, Common Mental Disorders, Depression, Exhaustion Disorder, Face-to-Face CBT, Guided Self-Help, Insomnia, Primary Care, Stepped care
National Category
Applied Psychology Psychiatry
Identifiers
URN: urn:nbn:se:su:diva-151293DOI: 10.1017/S0033291717003129ISI: 000444911300007PubMedID: 29095133OAI: oai:DiVA.org:su-151293DiVA, id: diva2:1172536
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-10-15Bibliographically approved

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Öst, Lars-GöranLekander, Mats
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