Guided self-help fails to benefit anxiety and depression patients
October 20, 2005
Guided self-help does not appear to provide additional benefit for patients with depression or anxiety who are waiting to receive psychological therapy, study findings show.
"A lack of trained therapists means that psychological therapy services cannot currently meet demand," note Nicola Mead, from the University of Manchester in the UK, and colleagues.
In an attempt to bridge the gap between demand and supply, services have considered a number of potential solutions.
Hypothesizing that guided self-help may be one such solution, the researchers randomly assigned 114 patients with depression or anxiety to receive guided self-help while on a waiting list to receive psychological therapy or no self-help guidance.
The guided self-help program involved two components: a written self-help manual, and one-to-one sessions with an assistant psychologist. The intervention included information about depression and anxiety as well as current treatments, along with a therapeutic section based on cognitive-behavioral principles.
All the patients were assessed at baseline and again 3 months prior to starting conventional psychological therapy.
The results, published in the journal Psychological Medicine, showed good adherence to the guided self-help intervention, with 88% of the 57 patients offered this service attending at least one session and 54% attending all four.
The self-help activities undertaken by the participants included trying to look at thoughts in a different way, keeping a diary of thoughts and feelings, confronting fears, doing more enjoyable activities, and doing more regular activities.
Indeed, at the end of the trial, over 90% of patients indicated that they would continue to use the manual.
However, the researchers report that, despite a good level of satisfaction reported with the intervention and evidence of a benefit in social functioning, there were no statistically significant differences between the two groups in anxiety and depression symptoms at 3 months.
Thus, "the results demonstrate that this model of guided self-help did not provide additional benefit to patients on a waiting list for psychological therapy," Mead et al conclude.
They propose that the use of relatively inexperienced staff to implement the intervention and the possibility that the patients tested were too mildly ill to demonstrate a benefit may have contributed to the negative effect of guided self-help in their study.
Source: Psychol Med 2005; 35: 1633–1643
Source: Psychiatry Source, 18/10/2005