Computerised cognitive-behavioural therapy for depression: systematic review

Kaltenthaler, Eva; Parry, Glenys; Beverley, Catherine; Ferriter, Michael

doi:10.1192/bjp.bp.106.025981

Cited by 188 publications

(160 citation statements)

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“…86 Other reviews showed that telemedicine, 78 internet-based interventions and support 82 and computerised CBT 81 improved symptoms. Positive effects were found in three of the four RCTs of computerised CBT for mild to moderate depression 85 and improvements in mental health were linked to the MoodGYM and BluePages programmes in particular. 84 Three of the five systematic reviews with meta-analyses considering mental health problems or anxiety disorders reported moderate to large effects for mental health and/or anxiety.…”

Section: Resultsmentioning

confidence: 99%

“…There was evidence of improved patient outcomes, including quality of life and medication adherence, for telehealth interventions for depression, [78][79][80]85,94 anxiety-related disorders 87,89 and post-traumatic stress disorder (PTSD). 88,95 Systematic reviews with meta-analyses for depression reported positive effects for telephone-based psychotherapy for depression, 79 internet-based CBT 80 and computerised psychological treatment.…”

Section: Resultsmentioning

confidence: 99%

“…We searched six databases for relevant systematic reviews that were published between January 2005 and March 2010. With regard to depression, we identified nine systematic reviews of telehealth and/or web-based interventions for depression, [78][79][80][81][82][83][84][85][86] three of which provided a meta-analysis. 79,80,86 We also identified 11 reviews about a range of mental health problems or anxiety disorders 15,40,[87][88][89][90][91][92][93][94][95] and, of these, five provided a meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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“…Non-acceptability -refusal to begin treatment -is a noted problem in the literature on cCBT 81 and it is likely to be especially relevant in routine primary care, where not all individuals are likely to be willing to try cCBT. 82 We therefore revised our original protocol to allow us to explore reasons for treatment refusal in an attempt to understand perceived barriers to using cCBT and to identify how treatment uptake can be improved. We thus amended the original protocol.…”

Section: Qualitative Studymentioning

confidence: 99%

A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

Littlewood

Duarte

Hewitt

et al. 2015

Health Technol Assess

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BackgroundComputerised cognitive behaviour therapy (cCBT) has been developed as an efficient form of therapy delivery with the potential to enhance access to psychological care. Independent research is needed which examines both the clinical effectiveness and cost-effectiveness of cCBT over the short and longer term.ObjectivesTo compare the clinical effectiveness and cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care against usual GP care alone, for a free-to-use cCBT program (MoodGYM; National Institute for Mental Health Research, Australian National University, Canberra, Australia) and a commercial pay-to-use cCBT program (Beating the Blues®; Ultrasis, London, UK) for adults with depression, and to determine the acceptability of cCBT and the experiences of users.DesignA pragmatic, multicentre, three-armed, parallel, randomised controlled trial (RCT) with concurrent economic and qualitative evaluations. Simple randomisation was used. Participants and researchers were not blind to treatment allocation.SettingPrimary care in England.ParticipantsAdults with depression who scored ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9).InterventionsParticipants who were randomised to either of the two intervention groups received cCBT (Beating the Blues or MoodGYM) in addition to usual GP care. Participants who were randomised to the control group were offered usual GP care.Main outcome measuresThe primary outcome was depression at 4 months (PHQ-9). Secondary outcomes were depression at 12 and 24 months; measures of mental health and health-related quality of life at 4, 12 and 24 months; treatment preference; and the acceptability of cCBT and experiences of users.ResultsClinical effectiveness:210 patients were randomised to Beating the Blues, 242 patients were randomised to MoodGYM and 239 patients were randomised to usual GP care (total 691). There was no difference in the primary outcome (depression measured at 4 months) either between Beating the Blues and usual GP care [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.75 to 1.88] or between MoodGYM and usual GP care (OR 0.98, 95% CI 0.62 to 1.56). There was no overall difference across all time points for either intervention compared with usual GP care in a mixed model (Beating the Blues versus usual GP care,p = 0.96; and MoodGYM versus usual GP care,p = 0.11). However, a small but statistically significant difference between MoodGYM and usual GP care at 12 months was found (OR 0.56, 95% CI 0.34 to 0.93). Free-to-use cCBT (MoodGYM) was not inferior to pay-to-use cCBT (Beating the Blues) (OR 0.91, 90% CI 0.62 to 1.34;p = 0.69). There were no consistent benefits of either intervention when secondary outcomes were examined. There were no serious adverse events thought likely to be related to the trial intervention. Despite the provision of regular technical telephone support, there was low uptake of the cCBT programs.Cost-effectiveness:cost-effectiveness analyses suggest that neither Beating the Blues nor MoodGYM appeared cost-effective compared with usual GP care alone.Qualitative evaluation:participants were often demotivated to access the computer programs, by reason of depression. Some expressed the view that a greater level of therapeutic input would be needed to promote engagement.ConclusionsThe benefits that have previously been observed in developer-led trials were not found in this large pragmatic RCT. The benefits of cCBT when added to routine primary care were minimal, and uptake of this mode of therapy was relatively low. There remains a clinical and economic need for effective low-intensity psychological treatments for depression with improved patient engagement.Trial registrationThis trial is registered as ISRCTN91947481.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme.

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“…But, they also highlights that the dropout rate in MoodGYM studies could be a problem [17]. Another systematic review of the computerized CBT delivery methods conducted by Kaltenthaler et al also highlights that the dropout rates for the different computerized CBT delivery methods are quite high [18]. The high dropout rates for the computerized CBT delivery could be due to usability and accessibility.…”

Section: Methodsmentioning

confidence: 99%

Mobile-Application Based Cognitive Behavior Therapy (CBT) for Identifying and Managing Depression and Anxiety

Addepally

Purkayastha

2017

Lecture Notes in Computer Science

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Abstract. Mobile technology is a cost effective and scalable platform for developing a therapeutic intervention. This paper discusses the development of a mobile application for people suffering with depression and anxiety. The application which we have developed is similar to a Cognitive Behavior Therapy (CBT) website, which is freely available on the internet. Past research has shown that CBT delivered over the internet is effective in alleviating the depressive symptoms in users. But, this delivery method is associated with some innate drawbacks, which caused user dropout and reduced adherence to the therapy. To overcome these shortfalls, from web based CBT delivery, a mobile application called MoodTrainer was developed. The application is equipped with mobile specific interventions and CBT modules which aim at delivering a dynamic supportive psychotherapy to the user. The mobile specific interventions using this application ensures that the user is constantly engaged with the application and focused to change the negative thought process. We present MoodTrainer as a self-efficacy tool and virtual CBT that is not meant to replace a clinical caregiver. Rather, it is a supportive tool that can be used to self-monitor, as well as a monitoring aid for clinicians.

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Computerised cognitive-behavioural therapy for depression: systematic review

Cited by 188 publications

References 14 publications

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

Mobile-Application Based Cognitive Behavior Therapy (CBT) for Identifying and Managing Depression and Anxiety

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