Patients were excluded if they (a) were currently receiving psychotherapy or
antidepressant drugs (
unless they had been
taking the same dose for at least three months without improvement); (b) were unwilling to accept randomisation or were unavailable for follow up; (c) met criteria for severe depression (melancholia) or had a history of bipolar affective disorder, schizophrenia, or substance misuse (as defined in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM - III - R) 18); or (d) were at significant risk of suicide or in need of urgent psychiatric treatment.