One-day cognitive-behavioural therapy self-confidence workshops could be a cost-effective way of reducing depression, according to a new study published today by the British Journal of Psychiatry.
Depression affects almost one in five adults in the UK. However, it remains vastly untreated with over half (54%) of people experiencing depressive episodes not contacting their GP. Cognitive-behavioural therapy (CBT) is an effective treatment for depression but, despite recent increases in funding for psychological services, waiting times remain long.
Researchers from the Institute of Psychiatry (IoP), King's College London, decided to trial the effectiveness of one-day workshops for treating people with depression. Traditional group CBT involves small groups of 8-10 people meeting for 10-12 two-hour sessions. However, delivering these more convenient one-day workshops based on CBT principles provides a lower-cost alternative and can reach up to 30 people per workshop.
The researchers ran the workshops in eight London boroughs. In order to make them more accessible, they were run at the weekend in community settings such as leisure centres and libraries. Members of the public did not have to be referred by their GPs but could self-refer in response to flyers advertising the workshops, which were titled 'How to improve yourself-confidence'. These were widely distributed in libraries, GP surgeries, community centres, leisure centres and pharmacies. Advertisements were also placed in local magazines.
People were invited to attend an introductory talk about the workshops, where they completed a questionnaire to screen for depression. In total, 1,042 people enquired about the workshops but after screening, 459 people – all aged over 18 and who had depression – were invited to participate in the trial. Of these, 228 of the participants took part in the one-day workshop which are run by psychologists, while the remaining 231 were assigned to a waiting list and acted as a control group. All the participants were followed up after 12-weeks, to determine if the workshop had improved their depressive symptoms.
At the 12-week follow-up, the researchers found that the depression scores of those people who completed the workshop were significantly lower than the control group, and women benefitted more than men. The workshop participants also reported lower levels of anxiety and increased self-esteem.
The researchers were interested to find that a quarter (25%)of the workshop participants had never consulted their GP about their depressive symptoms. They also found a much higher proportion (32%) of people from black and minority ethnic (BME) groups signed up for the workshops than expected. Participants represented 1.5 times the BME population in five boroughs, and twice the Asian population in three boroughs. Finally, the average cost of the intervention was relatively cheap, at £161 per person.
Lead researcher Dr June Brown, Senior Lecturer in Clinical Psychology at the Department of Psychology at the IoP at King's College London, said: "Our trial shows that self-confidence workshops are clinically effective at improving depression, reducing levels of anxiety and increasing self-esteem. What was also very important was that these workshops were designed to be very accessible. Many people with depression are reluctant to seek help from their GP, especially those from black and minority communities. But we found that advertising our workshops, using a'self-confidence' label, was an effective way of reaching out to members of the public with depression who had not previously sought help."
Dr Brown added: "How members of thepublic describe their psychological problems is extremely important. When we ran depression workshops, very few people came. We changed the label to self-confidence because there is a strong link between depression and low self-esteem, and many more people came forward. It is important to note that not all people who have self-confidence problems will have depression – in our study, about 20% who self-referred did not have depression. But the two are often linked."
Dr Brown concluded: "Our trial suggests that these accessible workshops – which are relatively cheap to run – can be a very effective way of engaging people with depression in treatment, and could help the under treatment of depression in the UK."
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Horrell L et al. "One-day cognitive-behavioural therapy self-confidence workshops for people with depression: randomised controlled trial." British Journal of Psychiatry, bjp.bp 112.121855