Academic journal article New Zealand Journal of Psychology

Help Yourself to CBT: Investigating Clinically Significant Change in a Low Intensity Programme for Low Mood

Academic journal article New Zealand Journal of Psychology

Help Yourself to CBT: Investigating Clinically Significant Change in a Low Intensity Programme for Low Mood

Article excerpt

Depression is a widespread and debilitating condition. It is estimated that depression will be the second highest disease-causing burden in the world by 2020 (World Health Organization, 1992). In New Zealand, depression is experienced by as many as 20% of women and 10% of men during their lifetime, and has an overall lifetime prevalence rate of 16% (Oakley Browne, Wells, Scott, & McGee, 2006). The proportion of Maori presenting with depression is substantially greater than New Zealand European, with nearly one in three experiencing major depressive disorder at some point in their lives (Baxter, 2008). The personal cost of depression includes significant clinical morbidity, increased mortality (particularly from suicide), diminished functioning, and decreased quality of life (see Barge-Schaapveld, Nicolson, Berkhof, & deVries, 1999; Hays, Wells, Sherbourne, Rogers, & Spritzer, 1995; Klerman & Weissman, 1992; Ustun, 1999).

Despite the prevalence, severity, and the negative impact of depression, it is treatable. There are successful evidence-based interventions available, including medication, psychosocial interventions, and psychotherapies such as cognitive behavioural therapy (CBT) (Beck, 1963, 1964; Beck, Rush, Shaw & Emery, 1979).

However, because of the high demand for mental health services and a lack of resources, only the most complex and chronic cases are typically accepted in treatment. Extensive waitlists, insufficient number of practitioners, and/or costs associated with therapy means psychological interventions are inaccessible for people who could potentially benefit from psychotherapy, i.e., those with mild to moderate levels of depression and anxiety. Therefore, those who would benefit the most from psychotherapy are the least likely to receive it, and those with the most severe conditions (such as severe clinical depression, bipolar disorder) and the least responsive to psychotherapy receive it; thus further exacerbating the problem of waitlists (Williams & Chellingsworth, 2010).

These problems have led to the recent development of low intensity interventions. Low intensity refers to the low usage of specialist therapist time (Bower & Gilbody, 2005), or the usage of the therapist's time in a cost-effective way. The primary purpose of low intensity cognitive behavioural interventions (LI-CBI) is to increase access to evidence-based psychological therapies on a community-wide basis, using the "minimum level of intervention necessary to create maximum gain" (Bennett-Levy & Farrand, 2010, p. 8). As the conceptual underpinnings of LI-CBI have already been discussed by Haarhoff and Williams (2017) in this issue, the principles will not be repeated here.

One example of LI-CBI is self-help. Self-help can play an important role in increasing the client's sense of control over and understanding of their mental health, thereby preventing relapse, reducing the amount of time spent in therapy, and increasing motivation (Keeley, Williams, & Shapiro, 2002). Self-help materials have come to be seen both as psychological interventions in their own right and as an adjunct to therapist-delivered care (Improving Access to Psychological Therapies [IAPT], 2010). As an intervention, self-help involves the delivery of materials that employ different media-based format, such as printed materials, digital, or web-based programmes. Whatever the means of delivery, self-help materials aim to increase the users' knowledge about a particular problem and equip them with skills to better self-manage their difficulties (Williams, 2003). For example, bibliotherapy and internet-delivered CBT for social anxiety have been shown to be effective as pure self-help models (Furmark et al., 2009).

Pure self-help, however, has been found to have high dropout rates and many do not complete the programme (Waller & Gilbody, 2009). A seminal review by Gellatly et al. (2007) demonstrated that practitioner support led to significantly improved outcomes compared to the use of self-help on its own. …

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