Objectives. To examine the clinical effectiveness of guided self-help (GSH) for anxiety and depression in routine clinical practice, and the role of self-efficacy, therapeutic alliance and socio-economic status in influencing that effectiveness. Design. A within-subjects repeated measures design in which participants served as their own controls by completing questionnaires across a control period prior to GSH intervention, then again at post-intervention and 3- and 6-month follow-up. Methods. GSH participants completed outcome measures for mental health (HADS) and work/social functioning (WSAS). Factors explored by regression as possible predictors of effectiveness were self-efficacy, therapeutic alliance and socioeconomic status. Results. Sixty people completed GSH, with analyses indicating effectiveness of GSH in significantly improving mental health and social functioning at post-treatment and 3-month follow-up, but not at 6-month follow-up. Effectiveness was also indicated under intent-to-treat conditions (n = 97) with medium effect sizes (≈ 0.6) for each outcome measure at post-treatment. Improvement in mental health was predicted by lower self-efficacy and greater therapeutic alliance. Completers of the intervention had significantly higher socio-economic status than non-completers. Conclusions. The current study has suggested effectiveness of GSH in routine clinical practice across different primary care services at post-treatment, but with less evidence of this at follow-up. Effectiveness has been highlighted to be influenced by self-efficacy and therapeutic alliance, suggesting the importance of considering non-specific factors when patients access GSH in primary care. This study underlines the need for further research exploring longer-term clinical effectiveness and examining for whom GSH works in order to constructively inform future evidence-based practice.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:633863 |
| Date | January 2011 |
| Creators | Coull, Greig Joseph |
| Contributors | Morris, Paul; Millar, Neil |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/9802 |
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