Self-guided psychological treatment has a small but significant impact on depression

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Self-guided psychological treatment is where a patient works through a programme of treatment without the aid of a therapist or coach.  There are now many Internet-based treatments for depression and anxiety and there have been a number of good quality trials published during the last few years on self-guided psychological treatments for depression.

There have also been a number of meta-analyses that have examined the effects of self-guided psychological treatment, but this is the first systematic review and meta-analysis on self-guided unsupported psychological treatment for patients with depressive symptoms.

The reviewers conducted a systematic literature search and found 7 randomized controlled trials that met their inclusion criteria, with a total of 1,362 respondents. The overall quality of the studies was high. A post-hoc power calculation showed that the studies had sufficient statistical power to detect an effect size of d = 0.19.

The overall mean effect size indicating the difference between self-guided psychological treatment and control groups at post-test was d = 0.28 (p<0.001), which corresponds to an NNT of 6.41. At 4 to 12 months follow-up the effect size was d = 0.23. There was no indication for significant publication bias.

The authors concluded:

This study showed that self-guided psychological treatment has a small but significant effect on participants with increased levels of depressive symptomatology. The next step is to examine whether such interventions can be implemented in routine practice in a stepped care model and whether the effects found in this meta-analysis will be found in regular clinical settings. We also encourage more research on predictors of outcome and reports of both responders and non-responders to unguided psychological treatment.

Cuijpers P, Donker T, Johansson R, Mohr DC, van Straten A, Andersson G. Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One. 2011;6(6):e21274. Epub 2011 Jun 21.

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