PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.
BACKGROUND
Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution.


OBJECTIVE
To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression.


METHODS
Randomised controlled trial.


METHODS
Seventeen primary healthcare teams.


METHODS
Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care.


RESULTS
Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56).


CONCLUSIONS
Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.
Leeds North West Primary Care Trust, Leeds.
Ann
A
Richards
Michael
M
Barkham
Jane
J
Cahill
David
D
Richards
Chris
C
Williams
Phil
P
Heywood
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods / Q000592:standards*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D017060:Patient Satisfaction; D012648:Self Care / Q000191:economics / Q000592:standards*