The demand for psychological therapies far outstrips the supply and in this ongoing period of austerity we surely need to produce some cost-effective alternatives.
One method that patients can attempt pretty much on their own is self-help provided through books, CDs, DVDs and websites.
This new systematic review claims to be the first to bring together the available evidence on the efficacy, cost-effectiveness and acceptability of multimedia self-help interventions for individuals diagnosed with an anxiety disorder.
The research team conducted a systematic literature search on a range of databases to identify randomised controlled trials (RCTs) of self-help interventions for anxiety disorders. They found 31 RCTs that met their inclusion criteria and well over half of these were good quality studies (i.e. adequate reporting of allocation concealment, adequate masking of outcome assessors etc).
The review covered a range of anxiety disorders:
- Generalised anxiety disorder (3 RCTs)
- Obsessive–compulsive disorder (2 RCTs)
- Panic disorder and/or agoraphobia (14 RCTs)
- Post-traumatic stress disorder (1 RCT)
- Social phobia (8 RCTs)
- Mixed anxiety disorders (3 RCTs)
Here’s what they found:
- Self-help compared with waiting list gave a significant effect size of 0.84 in favour of self-help
- Guided self-help (0.97) and web-based/multimedia self-help (0.90) showed even greater efficacy
- Self-help compared with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34
The authors conclude:
There is evidence that self-help interventions are effective in the treatment of social phobia and panic disorder. This provides support for the inclusion of self-help interventions in stepped care treatment models for these disorders. Methods of providing home treatment for these individuals, who are likely to be fearful of going out in public, has potential to increase engagement.
Further high-quality RCTs that include economic evaluation are now required, particularly of programmes addressing PTSD, OCD, GAD and specific phobias, which have received less attention in the literature than social phobia and panic disorder. Further research is also required to formally evaluate the acceptability of self-help approaches from the perspective of both patient and professional. This might take the form of qualitative research to explore attitudes and opinions. Evaluation of self-help interventions in the context of a stepped-care model would also be valuable.
The self-help approach has received growing recognition in a climate of limited resources and pressure on psychological services. This review confirms its potential for effectively treating individuals diagnosed with an anxiety disorder and supports the ongoing development of self-help programmes with potential for inclusion in stepped care treatment models.
It’s worth noting some of the limitations of this review:
- The 31 included RCTs covered a wide variety of self-help interventions so there was a great deal of heterogeneity across the data included in the meta-analysis
- The review only included published English language studies, which will have excluded a great deal of work published in Scandinavia and the Netherlands
- Sample sizes in trials were generally small, so the statistical power of the overall results is quite low
Lewis C, Pearce J, and Bisson JI. Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. BJP January 2012 200:15-21; doi:10.1192/bjp.bp.110.084756 [Abstract]
you say no jargon, but as a scientist i have no idea what significant effect size of 0.84 means?
Sorry about the statistical speak Jake.
The Cochrane definition of ‘effect size’ is:
1. A generic term for the estimate of effect of treatment for a study.
2. A dimensionless measure of effect that is typically used for continuous data when different scales (e.g. for measuring pain) are used to measure an outcome and is usually defined as the difference in means between the intervention and control groups divided by the standard deviation of the control or both groups.
In this systematic review the treatments being compared were self-help vs. waiting-list or self-help vs. therapist-administered CBT.
Self-help compared with waiting list gave a significant effect size of 0.84 in favour of self-help. That’s a considerable effect that shows people who received self-help are much more likely to recover than those who were put on the waiting list.
Hope that helps.
The Mental Elf