Article

Self-help interventions for depressive disorders and depressive symptoms: A systematic review

Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia.
Annals of General Psychiatry (Impact Factor: 1.53). 09/2008; 7:13. DOI: 10.1186/1744-859X-7-13
Source: PubMed

ABSTRACT Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.
A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.
The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John's wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.
A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.

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    • "Systematic reviews of research examining self-help interventions for anxiety and depressive disorders indicate their effectiveness (e.g. Bower et al. 2001 ; Morgan & Jorm, 2008), but temper their conclusions because of the heterogeneous mix of self-help interventions reviewed. Other reviews within the area have either not been systematic (e.g. "
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    ABSTRACT: Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically. A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted. Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals. Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression. Psychological Medicine 41(11) 2239-2252 http://dx.doi.org/DOI:10.1017/S0033291711000900
    Psychological Medicine 06/2011; 41(11):2239-52. DOI:10.1017/S0033291711000900 · 5.43 Impact Factor
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    • "A problem of almost all self - help strategies that have been proposed by respondents is that their efficacy has not been sufficiently tested . Strictly speaking , only two of them can be considered evidence based : St John ' s wort and exercise ( Morgan and Jorm , 2008 ) . There is weak evi - dence suggesting that bibliotherapy , based on a cognitive behavioural therapy approach , is useful for some people when they are given some additional guidance ( Anderson et al . "
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    ABSTRACT: While help-seeking and treatment preferences for depression have been assessed in a number of population studies, little is known about the public's self-help beliefs. To explore public beliefs about self-help actions to be taken in case of depression. In spring 2009, a population-based survey was conducted by telephone in the city of Vienna. A fully structured interview was carried out, which began with the presentation of a vignette describing a case of depression. Subsequently, respondents were asked to indicate to what extent they would recommend various self-help actions. Among the self-help options proposed, confiding in a close friend or someone in the family were most frequently recommended. Apart from that, a variety of interpersonal actions (socializing with others, joining a self-help group), psychological methods (thinking positively), lifestyle changes (engaging in sport, listening to music, going on vacation, reading a good book) and dietary methods (eating healthy food) were endorsed by over half of respondents. While women were more ready to recommend self-help actions, the better educated were less enthusiastic about them. As only some of the self-help measures endorsed by the public are evidence based, more research is needed before promulgating their use.
    International Journal of Social Psychiatry 05/2011; 58(4):343-9. DOI:10.1177/0020764010397262 · 1.15 Impact Factor
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    • "Several of the techniques often employed as components of BA packages have received empirical support as stand - alone interven - tions for depression ( activity scheduling , relaxation , and skills training ) , although it is clear that some interventions are more effective than relaxation alone ( Morgan & Jorm , 2008 ) . Several techniques have received empirical support as major components of treatment packages for other disorders ( relaxation , contingency management , and procedures targeting avoidance ) . "
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    ABSTRACT: Behavioral Activation (BA) for depression is an empirically supported psychotherapy with a long history dating back to the 1970s. To date there have been no systematic reviews of how BA treatment packages and their accompanying components have evolved over the years. This review sought to identify and describe the specific treatment components of BA based on the descriptions of techniques provided in empirical articles on BA and referenced treatment manuals when available. The following component techniques were identified: activity monitoring, assessment of life goals and values, activity scheduling, skills training, relaxation training, contingency management, procedures targeting verbal behavior, and procedures targeting avoidance. The implementation of these techniques is reviewed, along with their empirical support both as stand-alone components and as components of larger treatment packages. Whereas activity scheduling, relaxation, and skills training interventions have received empirical support on their own, other procedures have shown effectiveness as parts of larger treatment packages. Although BA interventions differed in tools used, activity monitoring and scheduling were shown to be constant components across interventions. Possible directions for the future evolution of BA are discussed.
    Clinical psychology review 04/2010; 30(6). DOI:10.1016/j.cpr.2010.04.001 · 7.18 Impact Factor
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