دورية أكاديمية
Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial.
| العنوان: | Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial. |
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| المؤلفون: | Salomonsson S; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden., Santoft F; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden., Lindsäter E; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden., Ejeby K; Department of Neurobiology,Care Sciences and Society (NVS),H1, Division of Family Medicine,Karolinska Institutet,Stockholm,Sweden., Ljótsson B; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden., Öst LG; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden., Ingvar M; Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden., Lekander M; Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden., Hedman-Lagerlöf E; Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden. |
| المصدر: | Psychological medicine [Psychol Med] 2018 Jul; Vol. 48 (10), pp. 1644-1654. Date of Electronic Publication: 2017 Nov 02. |
| نوع المنشور: | Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Cambridge University Press Country of Publication: England NLM ID: 1254142 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1469-8978 (Electronic) Linking ISSN: 00332917 NLM ISO Abbreviation: Psychol Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: London : Cambridge University Press Original Publication: London, British Medical Assn. |
| مواضيع طبية MeSH: | Outcome and Process Assessment, Health Care*, Cognitive Behavioral Therapy/*methods , Mental Disorders/*therapy , Primary Health Care/*methods , Self-Management/*methods, Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Young Adult |
| مستخلص: | Background: Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT. Methods: Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale. Results: After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. Conclusions: Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups. |
| فهرسة مساهمة: | Keywords: Adjustment Disorder; Anxiety; CBT; Common Mental Disorders; Depression; Exhaustion Disorder; Face-to-Face CBT; Guided Self-Help; Insomnia; Primary Care; Stepped care |
| تواريخ الأحداث: | Date Created: 20171103 Date Completed: 20190412 Latest Revision: 20191210 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1017/S0033291717003129 |
| PMID: | 29095133 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1469-8978 |
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| DOI: | 10.1017/S0033291717003129 |