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The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review

  • G. Coull (a1) and P. G. Morris (a1)
Abstract
Background

Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically.

Method

A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted.

Results

Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals.

Conclusions

Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression.

Copyright
Corresponding author
*Address for correspondence: Dr G. Coull, Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK. (Email: g.j.coull@sms.ed.ac.uk)
References
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Abramowitz JS, Moore EL, Braddock AE, Harrington DL (2009). Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry 40, 98105.
Andersson G, Bergstrom J, Hollandare F, Carlbring P, Kaldo V, Ekselius L (2005). Internet-based self-help for depression: randomised controlled trial. British Journal of Psychiatry 187, 456461.
Andersson G, Carlbring P, Holmstrom A, Sparthan E, Furmark T, Nilsson-Ihrfelt E, Buhrman M, Ekselius L (2006). Internet-based self-help with therapist feedback and in-vivo group exposure for social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 74, 677686.
Baguley C, Farrand P, Hope R, Leibowitz J, Lovell K, Lucock M, O'Neill C, Paxton R, Pilling S, Richards D, Turpin G, White J, Williams C (2010). Good practice guidance on the use of self-help materials within IAPT services. Technical Report. Improving Access to Psychological Therapies (IAPT) (http://www.iapt.nhs.uk/silo/files/good-practice-guidance-on-the-use-of-selfhelp-materials-within-iapt-services.pdf).
Beck A, Steer R, Brown G (1996). Manual for Beck Depression Inventory II (BDI-II). Psychological Corporation: San Antonia, TX.
Beck JG, Stanley MA, Baldwin LE, Deagle EA III, Averill PM (1994). Comparison of cognitive therapy and relaxation training for panic disorder. Journal of Consulting and Clinical Psychology 62, 818826.
Berger T, Hohl E, Caspar F (2009). Internet-based treatment for social phobia: a randomized controlled trial. Journal of Clinical Psychology 65, 10211035.
Bilich LL, Deane F, Phipps AB, Barisic M, Gould G (2008). Effectiveness of bibliotherapy self-help for depression with varying levels of telephone hotline support. Clinical Psychology and Psychotherapy 15, 6174.
Boer PCAM, Wiersma D, Russo S, Bosch RJ (2005). Paraprofessionals for anxiety and depressive disorders. Cochrane Database of Systematic Reviews. Issue 2, Art. No. CD004688.
Bouma J, Ranchor AV, Sanderman R, van Sonderen E (1995). Assessment of Depressive Symptoms with the CES-D. Manual [in Dutch]. Noordelijk Centrum voor Gezondheidsvraagstukken, Rijksuniversiteit Groningen: Groningen.
Bower P, Gilbody S (2005). Stepped care in psychological therapies: access, effectiveness and efficiency: narrative literature review. British Journal of Psychiatry 186, 1117.
Bower P, Richards D, Lovell K (2001). The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice 51, 838845.
Carlbring P, Bohman S, Brunt S, Buhrman M, Westling BE, Ekselius L, Andersson G (2006). Remote treatment of panic disorder: a randomized trial of internet-based cognitive therapy supplemented with telephone calls. American Journal of Psychiatry 163, 21192125.
Carlbring P, Ekselius L, Andersson G (2003). Treatment of panic disorder via the internet: a randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry 34, 129140.
Carlbring P, Gunnarsdottir M, Hedensjo L, Andersson G, Ekselius L, Furmark T (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry 190, 123128.
Carlbring P, Westling PE, Ljungstrand P, Ekselius L, Andersson G (2001). Treatment of panic disorder via the internet: a randomized trial of a self-help program. Behavior Therapy 32, 751764.
Christensen H, Griffiths KM, Jorm AF (2004). Delivering interventions for depression using the internet: randomised controlled trial. British Medical Journal 328, 265267.
Christensen H, Griffiths KM, Mackinnon AJ, Brittliffe K (2006). Online randomized controlled trial of brief and full cognitive behavioural therapy for depression. Psychological Medicine 36, 17371746.
Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, Wessely S (2002). A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment 5, 1173.
Clarke G, Eubanks D, Reid E, Kelleher C, O'Connor E, DeBar LL, Lynch F, Nunley S, Gullion C (2005). Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders. Journal of Medical Internet Research 7, e16.
den Boer PCAM, Wiersma D, Vaarwerk IT, Span MM, Dennis-Stant A, van den Bosch RJ (2007). Cognitive self-therapy for chronic depression and anxiety: a multi-centre randomized controlled study. Psychological Medicine 37, 329339.
den Boer PCAM, Wiersma D, van den Bosch RJ (2004). Why is self-help neglected in the treatment of emotional disorders? A meta-analysis. Psychological Medicine 34, 959971.
DoH (2005). Improving Access to Psychological Therapies Programme. Department of Health: London.
Febbraro GAR (2005). An investigation into the effectiveness of bibliotherapy and minimal contact interventions in the treatment of panic attacks. Journal of Clinical Psychology 61, 763779.
Furmark T, Carlbring P, Hedman E, Sonnenstein A, Clevberger P, Bohman B, Eriksson A, Hallen A, Frykman M, Holmstrom A, Sparthan E, Tillfors M, Nilsson-Ihrfelt E, Spak M, Eriksson A, Ekselius L, Andersson G (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry 195, 440447.
Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 12171228.
Goldberg D, Williams P (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.
Gould RA, Clum GA (1995). Self-help plus minimal therapist contact in the treatment of panic disorder: a replication and extension. Behavior Therapy 26, 533546.
Hegerl U, Hautzinger M, Mergl R, Kohnen R, Schutze M, Scheunemann W, Allgaier A, Coyne J, Henkel V (2010). Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients' choice arm. International Journal of Neuropsychopharmacology 13, 3144.
Jamison C, Scogin F (1995). The outcome of cognitive bibliotherapy with depressed adults. Journal of Consulting and Clinical Psychology 63, 644650.
Khan N, Bower P, Rogers A (2007). Guided self-help in primary care mental health: meta-synthesis of qualitative studies of patient experience. British Journal of Psychiatry 191, 206211.
Kupshik G, Fisher C (1999). Assisted bibliotherapy: effective, efficient treatment for moderate anxiety problems. British Journal of General Practice 49, 4748.
Lovell K, Bower P, Richards D, Barkham M, Sibbald B, Roberts C, Davies L, Rogers A, Gellatly J, Hennessy S (2008). Developing guided self-help for depression using the Medical Research Council complex interventions framework: a description of the modelling phase and results of an exploratory randomised controlled trial. BMC Psychiatry 8, 91.
Lovell K, Cox D, Garvey R, Raines D, Richards D, Conroy P, Repper D (2003). Agoraphobia: nurse therapist-facilitated self-help manual. Journal of Advanced Nursing 43, 623630.
Lovell K, Cox D, Haddock D, Jones C, Raines D, Garvey R, Roberts C, Hadley S (2006). Telephone administered cognitive behaviour therapy for treatment of obsessive-compulsive disorder: randomised controlled non-inferiority trial. British Medical Journal 333, 883887.
Lucock M, Padgett K, Noble R, Westley A, Atha C, Horsefield C, Leach C (2008). Controlled clinical trial of a self-help for anxiety intervention for patients waiting for psychological therapy. Behavioural and Cognitive Psychotherapy 36, 541551.
MacLeod M, Martinez R, Williams C (2009). Cognitive behaviour therapy self-help: who does it help and what are its drawbacks? Behavioural and Cognitive Psychotherapy 37, 6172.
Marks IM, Kenwright M, McDonough M, Whittaker M, Mataix-Cols D (2004). Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder. Psychological Medicine 34, 918.
Mayo-Wilson E, Montgomery P (2007). Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database of Systematic Reviews. Issue 1, Art. No. CD005330.
Mead N, MacDonald W, Bower P, Lovell K, Richards D, Roberts C, Bucknall A (2005). The clinical effectiveness of guided self-help versus waiting-list control in the management of anxiety and depression: a randomized controlled trial. Psychological Medicine 35, 16331643.
Morgan AJ, Jorm AF (2008). Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Annals of General Psychiatry 7, 13.
Newman M, Erickson T, Przeworski A, Dzus E (2003). Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? Journal of Clinical Psychology 59, 251274.
NICE (2004). Depression: management of depression in primary and secondary care – NICE guidance. Clinical guidelines CG23. National Institute for Clinical Excellence: London.
NICE (2007). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. Clinical guidelines CG22. National Institute for Clinical Excellence: London.
NICE (2009). Depression: the treatment and management of depression in adults (update). Clinical guidelines CG90. National Institute for Clinical Excellence: London.
Proudfoot J, Ryden C, Everitt B, Shapiro D, Goldberg D, Mann A, Tylee A, Marks I, Gray J (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 4654.
Reeves T (2010). A controlled study of assisted bibliotherapy: an assisted self-help treatment for mild to moderate stress and anxiety. Journal of Psychiatric and Mental Health Nursing 17, 184190.
Reeves T, Stace JM (2005). Improving patient access and choice: assisted bibliotherapy for mild to moderate stress/anxiety in primary care. Journal of Psychiatric and Mental Health Nursing 12, 341346.
Richards A, Barkham M, Cahill J, Richards D, Williams C, Heywood P (2003). PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care. British Journal of General Practice 53, 764770.
Salkovskis P, Rimes K, Stephenson D, Sacks G, Scott J (2006). A randomized controlled trial of the use of self-help materials in addition to standard general practice treatment of depression compared to standard treatment alone. Psychological Medicine 36, 325333.
Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M (2005). Internet-guided self-help with or without exposure therapy for phobic and panic disorders. Psychotherapy and Psychosomatics 74, 154164.
Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P (2009). Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomized controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders. BMC Health Services Research 9, 90.
Smit A, Kluiter H, Conradi HJ, van der Meer K, Tiemens BG, Jenner JA, van Os TWDP, Ormel J (2006). Short-term effects of enhanced treatment for depression in primary care: results from a randomised controlled trial. Psychological Medicine 36, 1526.
Sorby N, Reavley W, Huber J (1991). Self-help programme for anxiety in general practice: controlled trial of an anxiety management booklet. British Journal of General Practice 41, 417420.
Titov N, Andrews G, Choi I, Schwencke G, Mahoney A (2008 a). Shyness 3: randomized controlled trial of guided versus unguided internet-based CBT for social phobia. Australian and New Zealand Journal of Psychiatry 42, 10301040.
Titov N, Andrews G, Schwencke G (2008 b). Shyness 2: treating social phobia online: replication and extension. Australian and New Zealand Journal of Psychiatry 42, 595605.
Titov N, Andrews G, Schwencke G, Drobny J, Einstein D (2008 c). Shyness 1: distance treatment of social phobia over the internet. Australian and New Zealand Journal of Psychiatry 42, 585594.
van Boeijen CA, van Oppen P, van Balkom AJLM, Visser S, Kempe PT, Blankenstein N, van Dyck R (2005). Treatment of anxiety disorders in primary care practice: a randomised controlled trial. British Journal of General Practice 55, 763769.
van Straten A, Cuijpers P, Smits N (2008). Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial. Journal of Medical Internet Research 10, e7.
Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P (2008). Internet-based treatment for adults with depressive symptoms: randomized controlled trial. Journal of Medical Internet Research 10, e44.
Westen D, Morrison K (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology 69, 875899.
Williams C, Martinez R (2008). Increasing access to CBT: stepped care and CBT self-help models in practice. Behavioural and Cognitive Psychotherapy 36, 675683.
Zigmond AS, Snaith PR (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.
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