Cited by 1,084Psychotherapy Techniques and ApplicationsPsychiatric care and mental health servicesMental Health Treatment and Access

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Stepped care in psychological therapies: access, effectiveness and efficiency: Narrative literature review

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Bower, Peter, Gilbody, Simon·2005·British Journal of Psychiatry

DOI 10.1192/bjp.186.1.11

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Abstract

Background: There is a significant gap between the demand for psychological therapy services and the available supply. One proposal to overcome this problem is to increase efficiency of provision through the adoption of briefer ‘minimal interventions' within stepped care models. Aims: To examine the theoretical underpinnings of stepped care, together with the practicalities of the adoption of this system of care. Method: Narrative literature review. Results: The potential clinical and economic benefits of stepped care are dependent upon underlying assumptions of equivalence in terms of clinical outcomes, efficiency in terms of resource use and costs, and acceptability of ‘minimal interventions' to patients and therapists. Illustrative studies of these issues are considered. Conclusions: Although psychological services might benefit from the adoption of the stepped care model, a substantial research agenda needs to be fulfilled before a judgement can be made as to whether stepped care might be an efficient method of delivering psychological services.

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“…where a number of less intensive treatments (or ‘minimal interventions’) have been developed, for example brief therapies (Scott et al, 1997), group treatments (Dowrick et al, 2000) and self-help approaches such as bibliotherapy (Cuijpers, 1997) and computerised treatments (Proudfoot et al, 2004).”
Background
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Background
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Result
A stepped care intervention is effective for elderly people with subthreshold depression or anxiety
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Method
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“…R. lilienthal, Phd is now affiliated with gannett health services at cornell University. measurement as a part of clinical care facilitates accurate and timely treatment decisions, as these objective data inform clinicians’ decisions to “step-up” or “step-down” care (Bower & Gilbody, 2005).”
Background
Stepped care and mental health technologies
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Authors: Bower, P., & Gilbody, S.
Affiliations: University of Manchester (GB)
University of Leeds (GB)
Corresponding author: Bower, Peter
ORCID: Bower, Peter
Gilbody, Simon
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2005-01
Volume: 186
Issue: 1
Pages: 11-17
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.186.1.11
OpenAlex: W2160548159
Cited by: 1,084
References: 66
Citations by year: 2026: 76 · 2025: 61 · 2024: 71 · 2023: 72 · 2022: 73 · 2021: 62 · 2020: 68 · 2019: 63 · 2018: 65 · 2017: 51 · 2016: 62 · 2015: 55 · 2014: 48 · 2013: 45 · 2012: 54
FWCI: 3.42
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 4749 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: stepped care, psychotherapy, minimal intervention, brief intervention, access to mental health care, service supply and demand, treatment efficiency, cost-effectiveness, treatment acceptability, resource utilization (health care)
MeSH terms: Mental Disorders, Humans, Patient Acceptance of Health Care, Psychotherapy, Treatment Outcome

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