Agoraphobia: Nurse therapist-facilitated self-help manual

Background. Agoraphobia is a common and disabling mental health disorder. Substantial evidence supports the use of cognitive behaviour therapy (CBT), in particular the intervention termed exposure therapy, as the treatment of choice. However, although the evidence base for cognitive-behaviour therapy is extensive, the service delivery evidence base is poor, and alternative ways of delivering therapy are required if mental health services are to achieve standards set out by the National Service Framework in the United Kingdom. Aim. The study had two aims: (1) to develop a self-help manual, which could be facilitated by a nurse trained in CBT, for clients suffering from agoraphobia and (2) to pilot the self-help manual and evaluate its effectiveness. Method. The self-help manual was piloted with experienced nurses trained in CBT on three clinical sites for 10 weekly sessions of 30 minutes duration. A range of clinical outcome measures was administered by an independent assessor before and after treatment and at 1-month follow-up. Results. A total of 18 clients completed treatment and results showed improvement on all clinical measures; improvement was maintained at 1-month follow-up. Importantly, 89% of clients were clinically significantly improved at post-treatment assessment. Clients were satisfied with their treatment and the self-help manual, and therapists found facilitated self-help an acceptable way to deliver treatment. Conclusion. Nurses can deliver effective support to patients using a self-help manual for agoraphobia. Although the results are promising, further work is required with larger numbers, longer follow-up and economic evaluation under controlled conditions. The work could also be adapted to different psychological conditions. Variation in the amount of specialist educational training is necessary to determine how many nurses are needed to support patients using self-help.