Telephone-supported computerised cognitive–behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial

Abstract

Computerised cognitive-behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.We tested the benefits of adding telephone support to cCBT.We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5-3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI -0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.

Internet-Delivered Cognitive Behaviour Therapy

“…Interventions that did not include a support component obtained the lowest estimated effect size (d = 0.36). The results support the inclusion of any form of support, either a professional therapist, or a trained para-professional, or indeed a trained peer volunteer, or technician, as beneficial for optimising the efficacy of iCBT interventions [5,10,11]. Also, a recent individual service user data meta-analysis has shown that adherence to treatment predicts better outcomes [12].…”

The Internet and CBT: A New Clinical Application of an Effective Therapy

“…However, the adherence to the program did not increase substantially with 45% of patients completing the first session in the MoodGYM alone group and 65% completing the first session in the telephone-support group. An economic analysis indicated that telephone support could increase quality of life (in quality-adjusted life year [QALY]) and reduce healthcare costs with a likelihood of being cost effective at ₤6933 per QALY [36,37].…”

“…One study comparing in-person CBT and iCBT showed that iCBT patients required only 7.5% of the time that in-person patients needed to achieve similar gains [70]. Further, much of the iCBT support can be performed by trained staff rather than a clinician [37,71]. Many of the behaviors that therapists teach patients, such as task reinforcement, psychoeducation, and deadline flexibility [72], can be performed by trained staff rather than a clinician.…”

Measuring the Implementation of Behavioral Intervention Technologies: Recharacterization of Established Outcomes (Preprint)

“…[4,20] For example, in a recent large pragmatic effectiveness trial in the U.K., consumers used BITs for depression much less frequently than recommended, and the trial failed to demonstrate improvement in outcomes until telephone contact supporting BIT use was added. [21,22] Given that use of such programs outside of research settings has been limited, there is a growing recognition that BITs will not revolutionize healthcare without a better understanding of their implementation.…”