TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Cognitive Behavioral Therapy/methods
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Mental Disorders/therapy
KW - Middle Aged
KW - Outcome and Process Assessment (Health Care)
KW - Primary Health Care/methods
KW - Self-Management/methods
KW - Young Adult
KW - Adjustment Disorder
KW - Anxiety
KW - CBT
KW - common mental disorders
KW - Depression
KW - Exhaustion Disorder
KW - Face-to-Face CBT
KW - Guided Self-Help
KW - Insomnia
KW - primary care
KW - stepped care
AU - Sigrid Salomonsson
AU - Fredrik Santoft
AU - Elin Lindsater
AU - Kersti Ejeby
AU - Brjann Ljotsson
AU - Lars-Goran Ost
AU - Martin Ingvar
AU - Mats Lekander
AU - Erik Hedman-Lagerlof
A1 - 
AB - BACKGROUND: Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT. METHODS: Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale. RESULTS: After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. CONCLUSIONS: Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.
AD - Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.; Department of Neurobiology,Care Sciences and Society (NVS),H1, Division of Family Medicine,Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden.; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden.
BT - Psychological medicine
C5 - Healthcare Disparities
CP - 10
CY - England
DO - 10.1017/S0033291717003129
IS - 10
JF - Psychological medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT. METHODS: Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale. RESULTS: After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. CONCLUSIONS: Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.
PP - England
PY - 2018
SN - 1469-8978; 0033-2917
SP - 1644
EP - 1654
EP - 
T1 - Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial
T2 - Psychological medicine
TI - Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial
U1 - Healthcare Disparities
U2 - 29095133
U3 - 10.1017/S0033291717003129
VL - 48
VO - 1469-8978; 0033-2917
Y1 - 2018
Y2 - Jul
ER -