Table 4

Matrix used for synthesis of findings concerning the 'core components' of GSH

Level of guidance

Nature of guidance

Health Technology


Meta regression findings

Number of sessions not related to outcome

Better outcomes where guidance provided, and where based on CBT

No differences between technologies (email, telephone, face to face)


Meta synthesis findings

No relevant findings

No relevant findings

No relevant findings


Consensus exercise

Agreement on timing, duration, and number of sessions

Agreement that patient preference should determine the nature of guidance

Agreement that health technology should be accessible, and help with literacy problems.


Incorporated into the intervention

3–10 sessions, 15–30 minutes duration over 5–12 weeks

CBT based. Patient preference delivery of guidance

Devised a self-help manual and also a CD


Who should deliver guided self-help

Personal experience of depression

Ambivalent help seeking and covert presentation of problems


Meta regression findings

No differences in outcome between professional and paraprofessionals

No relevant findings

No relevant findings


Meta synthesis findings

No relevant findings

Personal experience characterised by feeling of inability to cope, and disturbances to functioning. Use of lay language/metaphors important

Point in illness trajectory where people make service contact, and their prior contact with other help may determine acceptability


Consensus exercise

Most frequent were nurses and primary care graduate workers. Specific training needed

Mixed response to inclusion of lay language and metaphors. Agreement on importance of social functioning, and relapse prevention

None relevant


Incorporated into the intervention

Primary care graduate workers or other mental health professionals

Emphasised return of social functioning. Lay language, metaphors and causal explanations included. Relapse prevention incorporated

Expectations and prior contact emphasised and included in the intervention. Choices and patient preference for interventions included


Control and helplessness in engaging with treatment

Stigma associated with treatment

Patients' understanding of self-help


Meta regression findings

No relevant findings

No relevant findings

No relevant findings


Meta synthesis findings

Patients reported coping strategies such as distraction, or the use of locations associated with feelings of safety and control

Extent to which guided self-help acknowledges issues of stigma likely to determine acceptability

Seeing the self as the agent of change may be very important


Consensus exercise

Mixed response but emphasis on collaborative working, patient centred goals, and roles i.e. patient as change agent

None relevant

Agreement of collaborative working, explicitly detail roles of both patient and MHW i.e. patient as change agent, coach as facilitator


Incorporated into the intervention

Highlighting intervention as a method of regaining control and incorporating use of coping strategies termed 'respite' in the intervention

Discussed guided self-help as requiring a sense of acting on the world and enhancing self-worth

Explicit team rationale, with the patient as 'team captain', facilitator renamed as 'self-help coach'


Lovell et al. BMC Psychiatry 2008 8:91   doi:10.1186/1471-244X-8-91

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