Cognitive-behavioural problem solving in the treatment of patients attending a medical emergency department: a controlled trial

Abstract

Previous research has pinpointed high levels of undetected psychiatric and psychosocial problems in medical attenders at an Accident and Emergency department (A&E). In a controlled trial, patients were selected if they fulfilled criteria which had been shown in the previous studies to be associated with high levels of psychopathology and repeat attendance at the A&E department. Patients were randomly allocated to either cognitive-behavioural problem solving treatment, or to a 'treatment as usual' control condition. The use of a brief, home-based treatment and assessments ensured 100% compliance. Results indicated only limited clinical benefits associated with such treatment. The reasons for the limited treatment response are considered; future treatments should be focused and evaluated in specifically defined problem and diagnostic groups. It is concluded that problem solving treatment should be confined to populations in which problem solving deficits have been identified, such as deliberate self-harm.