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Acceptability and effectiveness of CBT and psychologically based interventions for emergency department attenders with medical complaints: a systematic literature review

Published online by Cambridge University Press:  01 December 2022

Sally McGuire Open the ORCID record for Sally McGuire [Opens in a new window] ,
Mashal Hajar Safi  and
Jo Daniels Open the ORCID record for Jo Daniels [Opens in a new window]
Sally McGuire
Affiliation:
Avon and Wiltshire Partnership NHS Trust, Bristol, UK Department of Psychology, University of Bath, Bath, UK
Mashal Hajar Safi
Affiliation:
Department of Psychology, University of Bath, Bath, UK
Jo Daniels*
Affiliation:
Department of Psychology, University of Bath, Bath, UK
*
*Corresponding author. Email: j.daniels@bath.ac.uk
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Abstract

This systematic literature review surveyed the evidence for the acceptability and effectiveness of CBT and psychologically based interventions for emergency department (ED) attenders with physical health complaints as their primary concern, in light of over-burdened EDs and the existing evidence base for psychological interventions in other medical settings. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087860). A systematic search of three databases (APAPsychNet, Cochrane and PubMed) was performed to identify psychological treatment studies targeting physical health problems presenting in the ED, with broad inclusion criteria to capture a coherent understanding of the current knowledge base. A total of 2606 potential studies for inclusion were identified; 45 proceeded to full review. Twenty papers met the full inclusion. Included studies covered four clinical areas: trauma/PTSD-prevention, panic attacks, non-cardiac chest-pain and miscellaneous. A narrative description of findings reflected positive outcomes across all groups, but this was not consistent across any group. Few studies measured ED attendance (20%) or satisfaction/acceptability (10%). The majority of studies (90%) were underpinned by a cognitive behavioural framework, consistent with the current evidence base as applied to the management of medical conditions. Findings suggest there is some evidence that interventions in the ED are effective and acceptable to patients, but interpretation of findings is limited by the mixed quality of designs and risk of bias.

Key learning aims

  1. (1) To understand the current body of evidence for the feasibility and effectiveness of psychological interventions in the emergency department.

  2. (2) To gain a clear understanding of the models and format of the delivery of CBT and psychological interventions in an acute setting.

  3. (3) To identify gaps in the evidence to inform future development of CBT-based interventions to improve outcomes and clinical care.

Keywords

accident and emergencyCBTemergency departmentpsychological interventionssystematic review
Type
Review Paper
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e51
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Blane, D., Williams, C., Morrison, J., Wilson, A., & Mercer, S. (2013). Cognitive behavioural therapy: why primary care should have it all. British Journal of General Practice, 63, 103–104. https://doi.org/10.3399/bjgp13x663235 CrossRefGoogle Scholar
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