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Brief interventions ‘as effective as usual GP care’ for depression

By Lilian Anekwe

Brief interventions that deliver counselling, problem solving and cognitive behavioural therapy (CBT) in general practice are equally effective as treatments for depression and anxiety, a study shows.

The latest research evidence in support of psychological therapies comes days after the the Coalition Government comitted itself to ‘broaden the range of therapies available’, in the light of growing concerns that CBT was being invested in at the expense of other clinically useful therapies.

The meta-analysis published in the journal BMC Medicine, found six sessions in all three forms of psychological therapy were equally effective in patients with either depression or mixed anxiety with depression.

UK researchers analysed 34 studies involving 3, 962 patients – 22 of which were conducted in UK primary care. Of these, 13 trials delivered CBT, eight counselling and 12 problem-solving therapy.

There were small effects favouring brief CBT over usual GP care for both depression (with a standardised mean difference in trial outcomes of -0.33) and mixed anxiety and depression (with a difference of -0.26). There was a larger effect for brief CBT for anxiety disorders (of -1.06). All differences were statistically significant.

The effect sizes for CBT for anxiety and depression translated to a 2.3 point difference between groups offered a brief intervention and those given usual care on the Hamilton Rating Scale for Depression, and a 7.2 point improvement on the Hamilton Rating Scale for Anxiety.

But other therapies also showed benefits. Counselling was effective for mixed anxiety and depression (with a difference of -0.30). The effect size was smaller for problem solving therapy for both depression (difference of -0.26), and mixed anxiety and depression (difference of -0.17).

Lead researcher Dr John Cape, head of psychological therapies at Camden and Islington NHS Foundation Trust concluded: ‘Our meta-analysis suggests that brief CBT, counselling and PST were all effective in treating depression and mixed anxiety and depression. No significant difference was found between CBT, counselling and PST when controlling for diagnosis.’

The results came as health secretary Andrew Lansley pledged to continue the Labour government’s commitment to provide 3,600 extra psychological therapists by 2011 and pledged a £70m investment over the next year.

Mr Lansley said: ‘We want to offer long-term solutions to people with mental health problems and psychological therapies do that. We will broaden the geographical coverage of services and also the range of therapies available. This will help us to deliver more choice and give people better access to the right psychological support.’

RCGP chair Professor Steve Field welcomed the announcement, but Paul Farmer, chief executive of the mental health charity Mind warned: ‘Mental health services have long been an easy target when budgets are slashed, and we are delighted that the new Government will continue plans to invest in crucial talking treatments.

‘However, CBT is just one of a host of therapies that can be prescribed for mental health problems, and many people are still stuck on waiting lists struggling to access other therapies that are absolutely fundamental to mental health care, such as counselling.

‘The new Government should use this as an opportunity to expand IAPT to include the full spectrum of treatment that huge numbers of people need urgently, and many are currently kept waiting for.’

Psychological therapies are effective for depression and anxiety