Meta-review of the effectiveness of computerised CBT in treating depression

Sarrami, Pooria; Schneider, Justine; Assareh, Neda

doi:10.1186/1471-244x-11-131

Cited by 125 publications

(96 citation statements)

References 21 publications

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“…140 In efforts to avoid duplication of work, and to ensure that limited resources were used to maximum effect, the review team decided not to progress any further with the quantitative review of depression self-management support.…”

mentioning

confidence: 99%

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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mentioning

confidence: 99%

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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“…Among these, we can highlight the well-documented cognitive-behavioral therapy (CBT) 38,39 and positive psychotherapy. 40,41 CBT is a widely researched form of psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review

Freitas

Marques

Bevilaqua

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). Methods: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. Results: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. Conclusion: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies.

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“…Before we summarize the findings concerning t h e e f f i c a c y o f c C B T w e w o u l d l i k e t o mention that computers and the internet can not only be used as an alternative to the traditional form of CBT but also as an adjunct to the individual contact with a therapist [78]: For example a computer can be used as a tool for screening or diagnosis and information can be provided either in written or in audio/video formats. Furthermore, structured selfhelp programs can be provided online whereby situations can be easily simulated and graded exposure in highly controlled conditions is possible.…”

Section: New Developments In the Cbt For Depressionmentioning

confidence: 99%

“…Besides the easy accessibility and the potential to offer an approach in a nonstigmatizing environment there are some further advantages in conducting computerized CBT (cCBT). For instance, cCBT has the capacity to deliver structured input consistently with precision and is associated with comparably low costs [78]. Moreover, it has been shown that discontinuation of treatment is a problem that seems to be associated with faceto-face therapy [79].…”

Section: New Developments In the Cbt For Depressionmentioning

confidence: 99%

“…There are many cCBT programs developed for the treatment of depression named for example 'Colour Your Life' or 'Beating the Blues' and it has been shown that they are effective in the treatment of depression [81]. Foroushani and colleagues conducted a meta-review in which they included twelve systematic reviews covering results concerning the effectiveness of cCBT for mild to moderate depression [78]. This meta-review clarifies that while for single cCBT programs, as for example for 'ODIN', there is not enough data with good quality to conclude that they are really effective other cCBTs for depression, as for example 'MoodGYM', 'Beating the Blues', and 'Colour Your Life', have proven to be effective in reducing symptoms of depression.…”

Section: New Developments In the Cbt For Depressionmentioning

confidence: 99%

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