title: Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial.
abstract: BACKGROUND
  Access 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).
  
  
  OBJECTIVE
  GSH-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.
  
  
  RESULTS
  
  
  
  METHODS
  Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU.
  
  
  METHODS
  RCT 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.
  
  
  METHODS
  The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months.
  
  
  RESULTS
  Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change).
  
  
  CONCLUSIONS
  Weaknesses: 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.
  
  
  CONCLUSIONS
  GSH-CBT is substantially more effective than TAU.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN13475030.
authors: Institute of Health and Wellbeing, University of Glasgow, Strathclyde, Scotland, United Kingdom. chris.williams@glasgow.ac.uk
authors: Christopher
authors: C
authors: Williams
authors: Philip
authors: P
authors: Wilson
authors: Jill
authors: J
authors: Morrison
authors: Alex
authors: A
authors: McMahon
authors: Andrew
authors: A
authors: Walker
authors: Walker
authors: W
authors: Andrew
authors: Lesley
authors: L
authors: Allan
authors: Alex
authors: A
authors: McConnachie
authors: Yvonne
authors: Y
authors: McNeill
authors: Louise
authors: L
authors: Tansey
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome