Abstract
BackgroundNon-pharmacological interventions for depression may help patients manage their condition. Evidence from a recent large-scale trial (ACUDep) suggests that acupuncture and counselling can provide longer-term benefits for many patients with depression. This paper describes the strategies practitioners reported using to promote longer-term benefits for their patients.MethodsA qualitative sub-study of practitioners (acupuncturists and counsellors) embedded in a randomised controlled trial. Using topic guides, data was collected from telephone interviews and a focus group, altogether involving 19 counsellors and 17 acupuncturists. Data were audio recorded, transcribed verbatim and analysed using thematic content analysis.ResultsFor longer-term impact, both acupuncturists and counsellors encouraged insight into root causes of depression on an individual basis and saw small incremental changes as precursors to sustained benefit. Acupuncturists stressed the importance of addressing concurrent physical symptoms, for example helping patients relax or sleep better in order to be more receptive to change, and highlighted the importance of Chinese medicine theory-based lifestyle change for lasting benefit. Counsellors more often highlighted the importance of the therapeutic relationship, emphasising the need for careful “pacing” such that the process and tools employed were tailored and timed for each individual, depending on the “readiness” to change. Our data is limited to acupuncture practitioners using the principles of traditional Chinese medicine, and counsellors using a humanistic, non-directive and person-centred approach.ConclusionsLong-term change appears to be an important focus within the practices of both acupuncturists and counsellors. To achieve this, practitioners stressed the need for an individualised approach with a focus on root causes.
Highlights
Non-pharmacological interventions for depression may help patients manage their condition
Some of the optimism regarding the potential of selective serotonin re-uptake inhibitors (SSRIs) as a treatment for depression has faded in the light of concerns about effectiveness and safety
The sample for the qualitative sub-study included over half (56%) of the total number of therapists involved in the main trial
Summary
Non-pharmacological interventions for depression may help patients manage their condition. Evidence from a recent large-scale trial (ACUDep) [4] has suggested that acupuncture and counselling can provide longerterm benefits for many patients with on-going depression in primary care. We were keen to understand the experiences of those providing treatments (acupuncture or counselling) within the trial, and in particular the aspects of these interventions that practitioners perceived to be associated with their longer-term benefit. In doing so, these insights will help understanding of the interventions and help inform both clinical practice and any future research design
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