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SELF-HYPNOSIS FOR DEPRESSION IN PRIMARY CARE
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their choice of treatment will more readily engage in treatment for
depression (Dwight-Johnston, Unutzer, Sherbourne, Tang, & Wells,
2001) and other treatments (Cooper, Grant, & Garratt, 1997). Failure to
take account of this in depression-research design has resulted in
major recruitment problems; it has proved impossible to conduct RCTs
(Fairhurst & Dowrick, 1996; Simpson, Corney, Fitzgerald, & Beecham,
2000), and for years this has stalled progress in a vital field. We chose a
partially randomized preference (PRP) design as previously advocated
by Bradley and colleagues (Bradley, 1993, 1988; Brewin & Bradley,
1989) to do a feasibility study of a 12-week, self-help, self-hypnosis
program (see Figure 1). Using a benchmarking strategy (Merrill,
Tolbert, & Wade, 2003; Wade, Treat, & Stuart, 1998), we tested the
robustness of our results against similar studies. The information
about preferences and outcomes is examined in this article.
M
ATERIALS AND
M
ETHODS
Setting
We took referrals from within one NHS Local Health Care Coopera-
tive (LHCC) in the city of Edinburgh, with a population of approxi-
mately 85,000 patients and 80 general practitioners (GPs). GPs are an
autonomous group of primary-care physicians; in the National Health
Service in the United Kingdom they act as independent contractors
and as gatekeepers to secondary services. Ninety percent of patients
are solely treated by GPs in primary care; such patients do not see any
specific mental health professionals (Goldberg & Huxley, 1992). This
means that a very homogenous group of patients can be collected for
research purposes.
Patients
We asked GPs, during routine consultations, to identify eligible
patients aged between 18 and 65 years who were having a recent
episode of depression (first attack or recurrence) and for whom the
GPs intended to prescribe antidepressants. Exclusions included those
with bipolar depression, psychoses, current alcohol and drug use, a
depressive episode in the previous 6 months, or active suicidal
ideation.
Intervention
We chose to use a PRP trial design as previously advocated
by Bradley and colleagues (Bradley, 1993, 1998; Brewin & Bradley
1989) and as chosen by the two largest, most recent UK primary-care
trials of psychological versus antidepressant treatments (Bedi et al.,
2000; Ward et al., 2000). Patients were offered three choices: (a) to
receive self-help, self-hypnosis therapy (as per Figure 2); (b) to take
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