Community-based group guided self-help intervention for low mood and stress: randomised controlled trial

Abstract

Background: To date no studies have explored the effectiveness of written cognitive-behavioural therapy (CBT) resources for low mood and stress delivered via a course of self-help classes in a community setting. Aims To assess the effectiveness of an 8-week community-based CBT self-help group classes on symptoms of depression, anxiety and social function at 6 months (trial registration: ISRCTN86292664).

Method: In total, 142 participants were randomly allocated to immediate (n = 71) or delayed access to a low-intensity CBT intervention (n = 71). Measures of depression, anxiety and social function were collected at baseline and 6 months.

Results: There was a significant improvement for the primary outcome of Patient Health Questionnaire-9 (PHQ-9) score (mean between-group difference: -3.64, 95% CI -6.06 to -1.23; P = 0.004). The percentage of participants reducing their PHQ-9 score between baseline and 6 months by 50% or more was 17.9% for the delayed access group and 43.8% for the immediate access group. Secondary outcomes also improved including anxiety and social function. The intervention was cost neutral. The probabilities of a net benefit at willingness to pay thresholds of £20 000, £25 000 or £30 000 were 0.928, 0.944 and 0.955, respectively.

Conclusions: Low-intensity class-based CBT delivered within a community setting is effective for reducing depression, anxiety and impaired social function at little additional cost. Declaration of interest C.W. is president of British Association for Behavioural & Cognitive Psychotherapies (BABCP) - the lead body for CBT in the UK. He is also author of a range of CBT-based resources available commercially. He is developer of the LLTTF classes evaluated in this study. He receives royalty, and is shareholder and director of a company that commercialises these resources.

Conflict of interest statement

Conflict of interest

Professor Chris Williams is president of BABCP- the lead body for CBT in the UK, and a CBT researcher and trainer. He is also author of a range of CBT-based resources that address anxiety, depression and other disorders. These are available commercially as books, cCBT products, and classes. He is developer of the LLTTF classes evaluated in this study. He receives royalty, and is shareholder and director of a company that commercialises these resources. C-AM, LM, CH, AM and JM have no conflict of interests to declare.

Figures

Figure 1. CONSORT diagram of participant flow through the intervention.

Figure 2. Means and 95% confidence intervals of PHQ-9, GAD-7, HADS depression, HADS anxiety and WASAS scores for both groups at baseline and 6-month follow-up.

Figure 3. Cost-effective ratio (difference in cost / difference in QALY) and willingness to pay (£)

Figure 4. Cost and QALY - bootstrapped using stratified sampling and recycled predictions

Figure 5. Attendance survival curve.