Effectiveness of stress control classes: a multi-service practice research network study

The Stress Control (SC) programme (White & Keenan, 1990) is routinely provided in Improving Access to Psychological Therapies (IAPT) Services in England at step 2 in the stepped care model. SC is a group-based didactic intervention that teaches anxiety and depression coping skills. The content is similar to other CBT-based self-help interventions but it is often delivered to large groups in community settings, thereby potentially improving access and acceptability. I will describe a multi-service evaluation of the clinical and organisational effectiveness of stress control classes in IAPT services.
Clinical outcomes for 4,451 participants in 163 stress control interventions delivered across five IAPT services were analysed by calculating pre-post treatment anxiety (GAD-7) effect sizes (Cohen’s d). Overall and between-service effects were compared to published efficacy benchmarks. Multilevel modelling was used to examine if variability in clinical outcomes was explained by differences in service, group and patient-level (case-mix) variables. The findings were fed back to service users who attended SC in one of the IAPT services and they gave their views of their experiences and suggestions for future service improvements and research.
The pooled GAD-7 effect size for all services was d = 0.70, which was consistent with efficacy benchmarks for guided self-help interventions (d = 0.69). One service had significantly smaller effects (d = 0.48), which was explained by differences in group treatment length and case-mix, including socioeconomic context and initial severity. There was evidence of variability of outcomes between groups, explaining up to 3.6% of variance in treatment outcomes. Service users’ views included the value of taking a friend or family member to the classes, ways to engage and retain attenders and the importance of alternative therapy options for those who do not find SC classes acceptable or helpful. The presentation will consider the implications of the study for the role of SC classes in stepped care service model.