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Comparison of non-directive counselling and cognitive behaviour therapy for patients presenting in general practice with an ICD-10 depressive episode: a randomized control trial

Published online by Cambridge University Press:  08 October 2013

M. King*
Affiliation:
University College London Medical School, Mental Health Sciences Unit, Charles Bell House, London, UK
L. Marston
Affiliation:
Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
P. Bower
Affiliation:
NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, UK
*
*Address for correspondence: Professor M. King, University College London Medical School, Mental Health Sciences Unit, Second Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EH, UK. (Email: michael.king@ucl.ac.uk)

Abstract

Background

Most evidence in the UK on the effectiveness of brief therapy for depression concerns cognitive behaviour therapy (CBT). In a trial published in 2000, we showed that non-directive counselling and CBT were equally effective in general practice for patients with depression and mixed anxiety and depression. Our results were criticized for including patients not meeting diagnostic criteria for a depressive disorder. In this reanalysis we aimed to compare the effectiveness of the two therapies for patients with an ICD-10 depressive episode.

Method

Patients with an ICD-10 depressive episode or mixed anxiety and depression were randomized to counselling, CBT or usual general practitioner (GP) care. Counsellors provided nondirective, interpersonal counselling following a manual that we developed based on the work of Carl Rogers. Cognitive behaviour therapists provided CBT also guided by a manual. Modelling was carried out using generalized estimating equations with the multiply imputed datasets. Outcomes were mean scores on the Beck Depression Inventory, Brief Symptom Inventory, and Social Adjustment Scale at 4 and 12 months.

Results

A total of 134 participants were randomized to CBT, 126 to counselling and 67 to usual GP care. We undertook (1) an interaction analysis using all 316 patients who were assigned a diagnosis and (2) a head-to-head comparison using only those 130 (41%) participants who had an ICD-10 depressive episode at baseline. CBT and counselling were both superior to GP care at 4 months but not at 12 months. There was no difference in the effectiveness of the two psychological therapies.

Conclusions

We recommend that national clinical guidelines take our findings into consideration in recommending effective alternatives to CBT.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, AT, Steer, RA, Garbin, MG (1988). Psychometric properties of the Beck Depression Inventory; 25 years of evaluation. Clinical Psychology Review 8, 77100.Google Scholar
Blackburn, IM, James, IA, Milne, DL, Baker, C, Standart, S, Garland, A, Reichelet, FK (2001). The Revised Cognitive Therapy Scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy 29, 431446.Google Scholar
Brookes, ST, Whitely, E, Egger, M, Smith, GD, Mulheran, PA, Peters, TJ (2004). Subgroup analyses in randomized trials: risks of subgroup-specific analyses: power and sample size for the interaction test. Journal of Clinical Epidemiology 57, 229236.Google Scholar
Carpenter, JR, Kenward, MG (2007). Missing data in randomised controlled trials – a practical guide (http://www.hta.nhs.uk/nihrmethodology/reports/1589.pdf). Accessed September 2013.Google Scholar
Churchill, R, Hunot, V, Corney, R, Knapp, M, McGuire, H, Tylee, A, Wessely, S (2001). A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment 5, 1173.Google Scholar
Cooper, P, Osborn, M, Gath, D, Feggetter, G (1982). Evaluation of a modified self-report measure of social adjustment. British Journal of Psychiatry 141, 6875.Google Scholar
Derogatis, LR (1992). The Brief Symptom Inventory (BSI): Administration, Scoring and Procedures Manual, II. Psychometric Research Inc.: Baltimore.Google Scholar
Derogatis, LR, Melisaratos, N (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine 13, 595605.Google Scholar
Goldberg, DP, Cooper, B, Eastwood, MR, Kedward, HB, Shepherd, M (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 1823.Google ScholarPubMed
Greenberger, D, Padesky, CA (1995). Mind over Mood: A Cognitive Therapy Treatment Manual For Clients. Guilford Press: New York.Google Scholar
King, M, Sibbald, B, Ward, E, Bower, P, Lloyd, M, Gabbay, M, Byford, S (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technology Assessment 4, 183.Google Scholar
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.Google Scholar
Mellor-Clark, J, Simms-Ellis, R, Burton, M (2001). National survey of counsellors working in primary care: evidence for growing professionalisation? Occasional paper pp iv–7. Royal College of General Practitioners: London.Google Scholar
National Institute for Health and Clinical Excellence (2009). Depression: the treatment and management of depression in adults. Partial update of National Institute for Health and Clinical Excellence, clinical guideline 23 (http://www.nice.org.uk/nicemedia/pdf/cg90niceguideline.pdf). Accessed September 2013.Google Scholar
NHS (2009). Improving access to psychological therapies (http://publications.nice.org.uk/depression-in-adults-cg90). Accessed September 2013.Google Scholar
Padesky, CA, Greenberger, D (1995). Clinician's Guide to Mind over Mood. Guilford Press: New York.Google Scholar
Rogers, CR (1967). On Becoming a Person: A Therapist's View of Psychotherapy. Constable: London.Google Scholar
Royston, P (2005). Multiple imputation of missing values: update of ice. Stata Journal 5, 527536.Google Scholar
Rubin, DB (1987). Multiple Imputation for Non-Response in Surveys. John Wiley and Sons: New York.Google Scholar
Scottish Intercollegiate Guidelines Network (2010). Non-Pharmaceutical Management of Depression in Adults: A National Clinical Guideline. Scottish Intercollegiate Guidelines Network: Edinburgh.Google Scholar
Ward, E, King, M, Lloyd, M, Bower, P, Sibbald, B, Farrelly, S, Gabbay, M, Tarrier, N, Addington-Hall, J (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: clinical effectiveness. British Medical Journal 321, 13831388.Google Scholar
White, IR, Royston, P, Wood, AM (2011). Multiple imputation using chained equations: issues and guidance for practice (tutorial). Statistics in Medicine 30, 377399.Google Scholar
WHO (1992). International Statistical Classification of Disease and Related Health Problems, 10th revision. World Health Organization: Geneva.Google Scholar