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Stepped care in pri...
Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders : a randomized controlled trial
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- Salomonsson, Sigrid (författare)
- Karolinska Institutet
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- Santoft, Fredrik (författare)
- Karolinska Institutet
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- Lindsäter, Elin (författare)
- Karolinska Institutet
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- Ejeby, Kersti (författare)
- Karolinska Institutet
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- Ljótsson, Brjánn (författare)
- Karolinska Institutet
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- Öst, Lars-Göran (författare)
- Stockholms universitet,Klinisk psykologi,Karolinska Institutet, Sweden
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- Ingvar, Martin (författare)
- Karolinska Institutet
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- Lekander, Mats (författare)
- Stockholms universitet,Stressforskningsinstitutet,Karolinska Institutet, Sweden
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- Hedman-Lagerlöf, Erik (författare)
- Karolinska Institutet
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(creator_code:org_t)
- 2018
- 2018
- Engelska.
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Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 48:10, s. 1644-1654
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
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- BackgroundCommon mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.MethodsConsecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.ResultsAfter GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.ConclusionsStepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.
Ämnesord
- SAMHÄLLSVETENSKAP -- Psykologi -- Tillämpad psykologi (hsv//swe)
- SOCIAL SCIENCES -- Psychology -- Applied Psychology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
Nyckelord
- adjustment disorder
- anxiety
- CBT
- common mental disorders
- depression
- exhaustion disorder
- face-to-face CBT
- guided self-help
- insomnia
- primary care
- stepped care
- Psychology
- psykologi
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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