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PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care
Ann Richards1, Michael Barkham, Jane Cahill
1Leeds North West Primary Care Trust, Leeds.
Summary
Practice nurse-supported cognitive behavioural therapy self-help for anxiety and depression showed similar clinical outcomes and costs compared to usual GP care, with higher patient satisfaction. This approach offers a cost-effective, short-term benefit.
Area of Science:
- Primary Care Medicine
- Mental Health Services Research
- Evidence-Based Practice
Background:
- Mental health conditions are prevalent in primary care, accounting for up to 40% of General Practitioner (GP) consultations.
- Limited patient access to evidence-based psychological therapies necessitates alternative treatment strategies.
- Cognitive Behavioural Therapy (CBT) self-help interventions present a viable solution for managing common mental health issues.
Purpose of the Study:
- To compare clinical outcomes, patient satisfaction, and costs of a CBT-based self-help package facilitated by practice nurses versus standard GP care.
- To evaluate the effectiveness of facilitated CBT self-help for mild to moderate anxiety and depression in a primary care setting.
Main Methods:
- A randomized controlled trial was conducted across seventeen primary healthcare teams.
- Patients with mild to moderate anxiety/depression were randomized to either practice nurse-facilitated CBT self-help or ordinary GP care.
- The CBT self-help intervention involved up to three brief appointments over three months.
Main Results:
- Intention-to-treat analysis revealed comparable clinical outcomes and costs between the CBT self-help and ordinary care groups.
- Patients receiving facilitated CBT self-help reported higher satisfaction than those receiving ordinary care.
- On-treatment analysis indicated a higher likelihood of patients in the CBT self-help group falling below the clinical threshold at one month (OR=3.65) compared to the ordinary care group.
Conclusions:
- Facilitated CBT self-help offers a potentially cost-effective, short-term clinical benefit for primary care patients with mild to moderate anxiety and depression.
- This intervention could enhance primary care's capacity to offer diverse, effective psychological treatments alongside pharmacological options.
- Practice nurse-supported CBT self-help demonstrates potential as an accessible and satisfactory treatment modality.