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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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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