Table 5

Content of the Recovery programme guided self-help intervention

The key components of the intervention included a book [13] and guidance from a health professional. The intervention consisted of an evidence based health technology guided by a mental health professional (termed 'self-help coaches'), delivered over 3–10 sessions, 15–30 minutes per session over a period of 5–12 weeks. The book entitled the 'Recovery Programme for Depression' (also recorded onto CD-ROM) was divided into 4 steps. Details of the steps and their content can be found below.

The recovery book was written to engage patients, and incorporated metaphors, lay language and personal experience. The book was printed using colour, illustrations, and each step was colour coded for easy reference, and had a Flesch readability ease score of 74.0. The book, CD, and printed diaries were all placed in a plain black folder in an attempt to ensure a level of privacy for patients.

Mental health workers ('self-help coaches') attended a two day training programme which ran on both study site settings. The training focussed on all aspects of delivering the intervention from initial assessment, delivering the rationale for treatment and guiding patients with the materials. Training was accompanied by a training handbook (available from the authors). A significant portion of the training was spent practising self-help coach skills and working through the 4 steps of the book (using fictitious but typical cases of mild to moderate depression).

Step 1 'What is this recovery programme all about' introduced guided self help, emphasising the pivotal role of the patient as the agent of change and in control of their intervention. We highlighted this by stating that the recovery programme was about a 'team', with the patient as the 'team captain'. In addition we renamed the mental health workers (MHW) 'self – help coaches' and used the analogy of a personal fitness trainer to further highlight the view that the coaches were there to support, monitor and advise patients as opposed to the traditional therapist role. Case vignettes were used to demonstrate the personal experience of depression.

Step 2 'Understanding the way I feel' incorporated the notion that people's experience of depression is focussed on their inability to cope and loss of social functioning. This was addressed by suggesting that patients complete an 'Impact sheet' to highlight areas of loss or reduced functioning. We gave examples of typical metaphors people use to describe depression in lay language. The ABC model of emotion (feeling, thinking, and doing) was used to assist understanding of depression. Brief written exercises were included to assist engagement and understanding. To further ensure that the patient was in control of their treatment a section was included on devising patient centred goals, which were outcomes that the patient wanted to achieve.

Step 3 'My recovery programme' focussed on 3 evidence based interventions which were principally CBT based and included the rationale and application of behavioural activation, cognitive restructuring and ways to improve physical problems such as sleeping, irritability and concentration. These interventions were highlighted as a method of regaining control and thereby improving functioning. Patients were asked to choose the intervention that they thought would best help them. To assist this choice and ensure patient preference, patients were asked to read the 3 recovery stories at the end of the book. These stories were typical but fictional cases demonstrating people's experience of depression, guided self-help and recovering from depression using one of the 3 interventions.

Step 4 'Staying well and the recovery stories' focussed on advice and ideas on continuing to manage mood and relapse prevention. The recovery stories were fictitious (though based on clinical experience) accounts of people experiencing depression and managing depression using one of three interventions i.e. behavioural activation, life style changes or cognitive restructuring.

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

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