Abstract
BackgroundPsychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders.MethodsMeta-analysis and meta-regression of randomized controlled trials of brief psychological therapies of adult patients with anxiety, depression or mixed common mental health problems treated in primary care compared to primary care treatment as usual.ResultsThirty-four studies, involving 3962 patients, were included. Most were of brief cognitive behaviour therapy (CBT; n = 13), counselling (n = 8) or problem solving therapy (PST; n = 12). There was differential effectiveness between studies of CBT, with studies of CBT for anxiety disorders having a pooled effect size [d -1.06, 95% confidence interval (CI) -1.31 to -0.80] greater than that of studies of CBT for depression (d -0.33, 95% CI -0.60 to -0.06) or studies of CBT for mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08). Counselling for depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11) and problem solving therapy (PST) for depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05) were also effective. Controlling for diagnosis, meta-regression found no difference between CBT, counselling and PST.ConclusionsBrief CBT, counselling and PST are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief CBT for anxiety, which has comparable effect sizes.
Highlights
Psychological therapies provided in primary care are usually briefer than in secondary care
Effect size of psychological therapies The meta-analysis showed small effects favouring brief cognitive behaviour therapy (CBT) over usual general practitioner (GP) care for both depression [d -0.33, 95% confidence interval (CI) -0.60 to -0.06, k = 4, n = 450) and mixed anxiety and depression (d -0.26, 95% CI -0.44 to 0.08, k = 2, n = 479) and a larger effect for brief CBT for anxiety disorders
There were no studies of counselling or problem solving therapy (PST) for anxiety disorders alone, so it is not possible to establish from this review whether this is a specific differential effect of CBT or whether other brief psychological therapies might have greater effects on anxiety than depression
Summary
Psychological therapies provided in primary care are usually briefer than in secondary care. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders. Anxiety and depressive disorders are common, with estimated combined prevalence varying between countries but over 10% in most Western countries [1,2,3,4]. The majority of such patients are treated in primary care, with few patients referred on to secondary mental health services [5,6]. The only reviews covering the range of mental health disorders and types of psychological therapies used within primary care date back over a decade [23,24,25,26]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
