Brief behaviour change strategies for distressed patients in primary care
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5360 (Published 24 September 2019) Cite this as: BMJ 2019;366:l5360
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The article headline "Brief behaviour change strategies for distressed patients in primary care" and the content appears to be confusing two different goals of a brief psychosocial intervention as well who is to provide the intervention.
There are two types of evidence base referenced - two systematic reviews for brief psychosocial interventions for depressive or anxiety disorders [1,2] and a third systematic review of the effects of goal monitoring in achieving goals [3]. The infographic accopanying the article seems to make clear that this type of intervention is expected to take place in 15 minute appointments with GPs.
The two reviews describing effectiveness of brief psychosocial interventions in depressive or anxiety disorders [1,2] from my reading of the papers only include one study (same study in both reviews) which involves a GP delivering the intervention starting with one hour session followed by 30 minute sessions.
The third review describing goal management effectiveness [3] covers 138 papers which mostly focus on physical outcome such as weight change and physical activity and I counted only 4 papers which include mental health outcomes such as depression.
It should be made clearer therefore that the evidence for effectiveness of this proposed intervention of 15 minute appointments with GPs has little direct evidence of effectiveness for "distress" but there may be better evidence for the use of goal management in these brief 15 minute appointments in achieving outcomes such as increased physical activity or weight reduction although many of the interventions used seem to be the use of diaries or phone support or websites.
Taking elements of what may be helpful when provided by trained psychotherapists as part of a longer psychotherapy programme and expecting to achieve similar results is I suggest an extrapolation too far. It is important not to overstate the evidence that these types of interventions by GP as they may cause unwarranted confidence by both GP and patient and lead to subsequent frustration if they prove not to be effective in "distress" in the real world.
References
1, Linde K, Sigterman K, Kriston L, etal . Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam
Med 2015;13:56-68. 10.1370/afm.1719 25583894
2. Zhang A, Park S, Sullivan JE, Jing S. The effectiveness of problem-solving therapy for primary care patients’ depressive and/or anxiety disorders: A systematic review and
meta-analysis. J Am Board Fam Med 2018;31:139-50. 10.3122/jabfm.2018.01.170270 29330248
3. Harkin B, Webb TL, Chang BP, etal . Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence. Psychol Bull 2016;142:198-229. 10.1037/bul0000025 26479070
Competing interests: I hold in Diploma in Cognitive Therapy; I do not practise psychotherapy in my clinical practice but it could be construed in my response that I am wanting to keep the field of psychosocial interventions limited to only people trained in psychotherapy
Addendum to my previous letter
In addendum to my previous comment, I note that one of the systematic reviews [1] had one further study involving "primary care physicians" but with a first appointment of 30-45 minutes and two follow up sessions of 20-30 minutes which does not seem the model proposed in the infographic and unlikely to be feasible in clinical practice.
Reference
1. Zhang A, Park S, Sullivan JE, Jing S. The effectiveness of problem-solving therapy for primary care patients’ depressive and/or anxiety disorders: A systematic review and
meta-analysis. J Am Board Fam Med 2018;31:139-50.
Competing interests: Diploma in Cognitive Therapy