Psychological therapies given to people with depression, anxiety or mixed disorders in primary care are usually delivered over a shorter time period than in secondary care. In the UK, 6 sessions is a common treatment length, which contrasts to the 12-24 sessions that have been the subject of most trials of psychological therapies in secondary care settings.
This review and meta-analysis from a research team in London compares the effectiveness of these brief treatments compared to primary care treatment as usual by pooling the results of 34 randomised controlled trials.
Brief cognitive behaviour therapy came out well when compared with usual general practitioner care, with the best results favouring treatment of anxiety disorders:
- Anxiety disorders pooled effect size [d -1.06, 95% confidence interval (CI) -1.31 to -0.80]
- Depression (d -0.33, 95% CI -0.60 to -0.06)
- Mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08)
Brief counselling was also shown to be effective for depression and mixed anxiety and depression when compared to usual general practitioner care:
- Depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11)
Brief problem-solving therapy versus usual general practitioner care was also an effective treatment for depression and mixed anxiety and depression:
- Depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05)
A meta-regression was conducted, controlling for diagnosis, which found no difference between cognitive behavioural therapy, counselling and problem-solving therapy.
The authors concluded:
Brief cognitive behavioural therapy, counselling and problem-solving therapy are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief cognitive behavioural therapy for anxiety, which has comparable effect sizes.
Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010 Jun 25;8:38.