title: Patients' experiences of acupuncture and counselling for depression and comorbid pain: a qualitative study nested within a randomised controlled trial.
abstract: BACKGROUND
  Depression and pain frequently occur together and impact on outcomes of existing treatment for depression. Additional treatment options are required. This study aimed to explore patients' experiences of depression, the processes of change within acupuncture and counselling, and the elements that contributed to longer-term change.
  
  
  METHODS
  In a substudy nested within a randomised controlled trial of acupuncture or counselling compared with usual care alone for depression, semistructured interviews of 52 purposively sampled participants were conducted and analysed using thematic analysis.
  
  
  RESULTS
  Differences were reported by participants regarding their experience of depression with comorbid pain compared with depression alone. Along with physical symptoms often related to fatigue and sleep, participants with depression and comorbid pain generally had fewer internal and external resources available to manage their depression effectively. Those who had physical symptoms and were receiving acupuncture commonly reported that these were addressed as part of the treatment. For those receiving counselling, there was less emphasis on physical symptoms and more on help with gaining an understanding of themselves and their situation. Over the course of treatment, most participants in both groups reported receiving support to cope with depression and pain independently of treatment, with a focus on relevant lifestyle and behaviour changes. The establishment of a therapeutic relationship and their active engagement as participants were identified as important components of treatment.
  
  
  CONCLUSIONS
  Participants with and without comorbid pain received acupuncture or counselling for depression, and reported specific identifiable treatment effects. The therapeutic relationship and participants' active engagement in recovery may play distinct roles in driving long-term change. Patients who present with depression and physical symptoms of care may wish to consider a short course of acupuncture to relieve symptoms prior to a referral for counselling if needed.
  
  
  BACKGROUND
  ISRCTN63787732.
authors.affiliation: Department of Health Sciences, University of York, York, North Yorkshire, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Hopton
authors.affiliation: Department of Health Sciences, University of York, York, North Yorkshire, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Eldred
authors.affiliation: Department of Health Sciences, University of York, York, North Yorkshire, UK.
authors.forename: Hugh
authors.identifier: http://orcid.org/0000-0003-4255-4768
authors.initials: H
authors.lastname: MacPherson
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications* / Q000628:therapy*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D017060:Patient Satisfaction; D036301:Qualitative Research; D055815:Young Adult
keywords: Depression; Mental Health; Pain Management; Primary Care