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British Journal of General Practice

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Research Article

PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.

Ann Richards, Michael Barkham, Jane Cahill, David Richards, Chris Williams and Phil Heywood
British Journal of General Practice 2003; 53 (495): 764-770.
Ann Richards
Leeds North West Primary Care Trust, Leeds.
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Michael Barkham
Leeds North West Primary Care Trust, Leeds.
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Jane Cahill
Leeds North West Primary Care Trust, Leeds.
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David Richards
Leeds North West Primary Care Trust, Leeds.
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Chris Williams
Leeds North West Primary Care Trust, Leeds.
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Phil Heywood
Leeds North West Primary Care Trust, Leeds.
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Abstract

BACKGROUND: Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution. AIM: To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression. DESIGN OF STUDY: Randomised controlled trial. SETTING: Seventeen primary healthcare teams. METHOD: Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care. RESULTS: Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56). CONCLUSION: Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.

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British Journal of General Practice: 53 (495)
British Journal of General Practice
Vol. 53, Issue 495
October 2003
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PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.
Ann Richards, Michael Barkham, Jane Cahill, David Richards, Chris Williams, Phil Heywood
British Journal of General Practice 2003; 53 (495): 764-770.

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PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.
Ann Richards, Michael Barkham, Jane Cahill, David Richards, Chris Williams, Phil Heywood
British Journal of General Practice 2003; 53 (495): 764-770.
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Print ISSN: 0960-1643
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