Self-confidence workshops improve depressive symptoms

Self-confidence workshops improve depressive symptoms, distress and self-esteem significantly, according to a study published in the December issue of the British Journal of Psychiatry.

Despite the availability of effective treatments, the prevalence of depression in European countries has not fallen in recent years. Problems have included people's reluctance to consult primary care doctors, and the limited capacity of psychological services.

This study set out to examine the effectiveness of a psycho-educational intervention designed to be easily accessible. A series of day-long workshops for up to 25 people was run in southeast London, designed to improve self-confidence and so reduce depression, given the link between depression and low self-esteem.

Publicity material was distributed over a three-month period, inviting people interested in improving their self-confidence to telephone for further information. To reduce stigmatisation, the workshops took place in a leisure centre rather than in a mental health care setting. They were held on a Sunday to enable as many people as possible to attend.

Cognitive-behavioural techniques were used, and the day's programme was structured into four sessions:

• information was given about the development of low self-confidence and its emotional aspects, including depression
• cognitive aspects of low self-confidence were explored, specifically identifying and challenging negative thoughts
• behavioural methods for improving low self-confidence were taught, including problem-solving and assertiveness
• the final session was devoted to action planning, with participants setting their own homework targets to start improving their confidence.

The study used a randomised controlled design, comparing participants with a group of controls on a waiting list for the workshops. Three months after each workshop, a two-hour follow-up meeting was organised for participants to complete self-assessment forms, report on their progress and discuss any problems.

134 people attended the introductory talks, many of whom had not consulted primary care services. 120 agreed to participate in the study. Of the 60 referred to the experimental group, 44 attended their assigned workshop and 40 of these were successfully followed up. 83% of those who attended the introductory talks were women, and 46% were single.

It was found that attending the workshops produced significant reductions in depression and distress, as well as improvements in self-esteem. 45% of the experimental group improved compared with 8% of the control group.

The study seemed to support the authors' prediction that the change of title from 'Depression' to 'Self-confidence' helped reach the elusive group of people with depression who do not seek medical help. Given the problems of offering effective treatment to people, this is an important finding.

Three-quarters of those who self-referred to the workshops were identified as probable cases of depression, indicating that these were not simply a group of the 'worried well'. The workshops also seemed to attract a population reasonably representative of the local community in terms of ethnic background and employment status.

A larger, more rigorous randomised controlled trial is required to confirm the effectiveness and potential cost-effectiveness indicated by this study.