Effectiveness of stress control large group psychoeducation for anxiety and depression: Systematic review and meta-analysis.

Abstract

This review sought to evaluate the effectiveness of the 'Stress Control' (SC) large psychoeducational 6-session group programme developed to increase access to treatment for patients with anxiety and depression. Systematic review and meta-analysis (Prospero registration: CRD42020173676). Pre-post and post-treatment follow-up effect sizes were extracted and synthesized in a random effects meta-analysis, and variations in effect sizes were investigated via moderator analyses. Secondary analyses synthesized between-group effect sizes from controlled studies containing comparator treatments and calculated the average dropout rate. The quality of the meta-analysis was assessed using the GRADE approach. Nineteen studies with pre-post treatment outcomes were included. The average group size was N=39, and the average dropout rate was 34%. Pooled effect sizes indicated moderate pre-post treatment reductions in anxiety (ES=0.58; CI 0.41 to 0.75; N=5597; Z=7.13; p<.001), moderate reductions in depression (ES=0.62; CI 0.44 to 0.80; N=5538, Z=7.30; p<.001), and large reductions in global distress (ES=0.86; CI 0.61 to 1.11; N=591; Z=7.41; p<.001). At follow-up, improvements in anxiety, depression, and global distress were maintained. When SC was compared to active and passive controls, outcomes were equivalent for anxiety (ES=0.12, 95% CI -0.25 to 0.49, Z=-0.70; p=.482) and depression (ES=0.15, 95% CI -0.24 to 0.54, Z=0.84; p=.401). SC appears to be a clinically effective and durable low-intensity group intervention that facilitates access to treatment for large patient numbers. However, conclusions are limited by the low methodological quality of the evidence. The stress control version of large group psychoeducation is appropriate and effective for mild-to-moderate anxiety and depression The evidence base for stress control is predominantly made up of practice-based studies Stress control needs to form one component of the overall offer made to patients presenting with mild-to-moderate anxiety and depression The competencies required to deliver such groups need better specification.