Can 'self-confidence workshops' for depression help the implementation of the NICE Guidelines?

Plain English Summary

Background and study aims
By 2030, it is predicted that depression will be the leading cause of disease burden across the world. However, people are often reluctant to seek help. In the UK, 54% of people who were depressed did not contact their general practitioner (GP). In addition, although the public prefer psychological treatment to medication for depression, psychological services have been very small. In the UK, people used to need to be referred to psychological treatment services. Despite a recent increase in funding, the capacity of psychological treatment services remains limited, particularly for people with more severe problems. In addition, black and minority ethnic (BME) groups are often under-represented in psychological treatment services. Cognitive behaviour therapy (CBT) is as effective as medication for moderate to severe depression, and has long-term benefits. The NICE clinical guidelines in the UK recommend intensive individual CBT for those with moderate or severe depression, whereas individuals with mild to moderate depression are offered a range of treatments including computerised CBT, guided self-help and group CBT. Traditional CBT groups tend to be small, with 8-10 participants meeting for 10-12 two-hour sessions. Another alternative approach is to offer larger scale psycho-educational CBT groups that can reach more people. ‘Psycho-educational’ means that techniques are adapted into a teaching format so that larger numbers of people, say 25-30 people, can be reached. However, psycho-educational interventions advertised as ‘depression’ workshops attracted few people, and most people had already used specialist services. Changing the name of the workshops to a more user-friendly label of ‘self-confidence’ workshops led to a more people self-referring, with 39% of self-referrers never having previously seen their GP for depression. When one-day self-confidence workshops, to which people could refer themselves, were compared with a waiting list control group in a small study, it was found that the workshops were effective in reducing depression and improving self-esteem after 12 weeks. A 2-year follow-up study found that the benefits were maintained but only for those who were depressed. Our study aimed to assess whether the self-confidence workshops were effective clinically, and also to measure their cost and value for money in different parts of South London, focussing just on people with depression. We also wanted to assess access by difficult to engage groups such as black and minority ethnic (BME) groups and those who had not consulted their GPs. If shown to be successful, this could provide an alternative effective psychological intervention that was good value for money for people with depression in the community, given the low take-up for treatment for depression and people’s preference for psychological treatment.

Who can participate?
Depressed people aged 16 years or over, either sex.

What does the study involve?
Publicity about the workshops was sent round to the community and anyone with problems of low self-confidence was invited to self-refer to the workshops. All individuals who phoned or emailed to register were invited to a one-hour group introductory talk where further information about the workshops was given and informed consent obtained before participants completed assessments at the beginning of the study. For those people who could not attend the talk, the researchers offered an individual telephone assessment. Participants were randomly allocated either to receive the one-day self-confidence workshop after 3 weeks or to wait for 12 weeks for the same workshop (waiting list group). At follow-up for those who had attended the immediate workshop, a two-hour group meeting was held when outcome measures were completed. Participants in the waiting list group were advised to see their GP as usual during the 12-week waiting period. When they were invited to attend their workshop, outcome measures were collected immediately before they attended the workshop. Study participants who did not complete the assessments were posted outcome assessment questionnaires. Participants who completed the forms got feedback about changes they had made on the assessment forms. Those participants who were not depressed were not included in the study and but did get a place on a separate workshop.

What are the possible benefits and risks of participating?
Participants who attended the self-confidence workshops could have benefited from improvements in their symptoms of depression. We think there were few risks. There were no side effects from the CBT. We tried to safeguard confidentiality risks by ensuring data was kept confidential. We were keen to ensure people were making fully informed decisions to participate in the study. If people were distressed at the workshop, we had a backup clinical arrangement so that they could speak to a clinician. At follow-up, if participants still felt they needed help, they were advised about where to go.

Where is the study run from?
King’s College London (UK).

When is the study starting and how long is it expected to run for?
The study ran from April 2010 to November 2011.

Who is funding the study?
National Institute for Health Research (NIHR), Sutton and Merton Primary Care Trust, Wandsworth Primary Care Trust, Lewisham Primary Care Trust, Kingston Primary Care Trust, and Maudsley Charitable Trust.

Who is the main contact?
Dr June Brown

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centre

Sponsor information

King's College London (UK)
University/education

Strand
London
WC2R 2LS
England
United Kingdom

Website	http://www.kcl.ac.uk/
"ROR"	https://ror.org/0220mzb33

Funders

Funder type

Government

Results and Publications

Study outputs

Editorial Notes

15/02/2019: Publication reference added.