BACKGROUND: Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT's effectiveness across delivery formats in primary care.
OBJECTIVE: To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care.
METHODS: A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants.
RESULTS: Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multi-modal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37).
CONCLUSIONS: The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT's economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.
A meta-analysis shows that CBT is more effective than usual care in primary care. Not really news, and getting this provided is a policy financial issue out of the hands of most primary care doctors (but not their policy makers or service purchasers).
Yet more evidence that CBT works in the management of anxiety and depression. What's key is to spread a CBT format that is brief and effective and easy to perform in the Primary Care setting.
I understand the need for the study, but it does not surprise me that CBT is effective when delivered by trained psychotherapists, regardless of the setting. It would have been quite remarkable / newsworthy if the GPs themselves were providing the CBT.
Nice meta-analysis. As a psychiatrist, the improvement in the availability and quality of treatment by front-line medical practitioners for anxiety and depressive disorders is a positive step forward. Two interesting points: patients with anxiety improved more than those with depressive disorders, and having a person involved was more effective than a computer-based intervention without professional contact. The fidelity to protocol is required in research studies, but in the "real world" human contact adds to its efficacy. I suspect depression is a more heterogeneous condition, and screening instruments may not capture the entire spectrum of the syndrome. The real question is what to do with non-responders - mental health referral, psychotropic medications, more intensive DBT, or combination therapy?