Programme no. 459-P
Quality Improvement
Randomized comparison of a novel variant of cognitive behavioral therapy and standard psychotherapeutic care among women in primary care
Imri Demisai*1, Maria Larsson2, Staffan Svensson3, Kjell Reichenberg4
1Research and Development Primary Care Gothenburg and Södra Bohuslän,University of Gothenburg,Gothenburg,Sweden, 2Research and Development Primary Care Gothenburg and Södra Bohuslän,University of Gothenburg,Gothenburg,Sweden, 3Research and Development Primary Care Gothenburg and Södra Bohuslän,University of Gothenburg,Gothenburg,Sweden, 4Research and Development Primary Care Gothenburg and Södra Bohuslän,University of Gothenburg,Gothenburg,Sweden
* = Presenting author
Objectives: Compare a novel treatment method developed by the first author (ID) with standard primary care psychotherapeutic treatment.
Background: Various psychotherapeutic methods have been tested to prevent sickness absence from work. Women with mental health problems are at increased risk of sick leave.
Results: Participants in the experimental group had somewhat larger, but not statistically significant, decreases in HADS-A and HADS-D from baseline to 6 and 12 months in comparison with standard treatment. The increase in SOC, where higher scores indicate higher sense of coherence, was slightly more pronounced in the experimental group, p=0.03 at 12 months.

Despite randomization patients in the experimental group were younger than those in the standard treatment group and fewer of them took psychotropic drugs at baseline.

Material/Methods: 153 women aged 20-60 years were referred to a psychosocial team at a primary care centre, 79 of these were eligible and 36 agreed to participate. They presented symptoms of anxiety, depression or diffuse muscle pain and were currently on or deemed at risk for sick-leave. 18 were randomized to the standard individual treatment and 18 to the experimental treatment. This consisted of 5 individual 90-minute consultations and 7 group meetings with 5-6 participants, 120 minutes each. The novel treatment was based on cognitive behavioral theory as well as systems therapy with emphasis on the importance of social context and family myths.

Changes in legislation during the study period prevented the use of sick leave as outcome. Instead the subscales of The Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and the 29-item version of Antonovsky’s Sense of Coherence Scale (SOC) were used.

The study was approved by the Regional Ethical Review Board in Gothenburg. No authors reported any conflict of interests.

Conclusion: The experimental treatment showed similar or somewhat better outcomes than standard treatment. The results must be interpreted with caution due to group differences in baseline symptoms and psychotropic drug use. Possible sources of bias are gender constellation effects (ID is male, all other therapists female, all patients female), and the fact that ID is a strong proponent of the novel method which may have prompted socially desirable responses. The inclusion rate was low, raising concerns about generalizability.
Points for discussion: What is the value of non-manualized psychotherapy methods in primary health care?