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Computer assisted CBT provides little or no benefits for depression

Date: 22 December 2015

Computer assisted cognitive behavioural therapy is likely to be ineffective in the treatment of depression because of low patient adherence and engagement, suggests the largest study of its kind published in The BMJ.

The full report has now published in Health Technology Assessment.

Cognitive behavioural therapy (CBT) is considered an effective "talking treatment" for depression, but is not always immediately available in the NHS. Computerised CBT (cCBT) has recently been developed and to increase access to this form of treatment.

However, it is unknown how effective cCBT is for patients with depression in a primary care setting, where most depression is managed, and the two most widely used computer programmes have not been compared. 

The NIHR HTA Programme funded researchers from the University of York to conduct a randomised control trial, the REEACT study, to assess the effectiveness of cCBT when added to usual GP care, and compare two commonly used CBT packages to see if these have additional benefits. The Packages used were Beating the Blues" and the free-to-use "MoodGYM". 

In total, 691 patients with depression from 83 general practices across England were enrolled in the REEACT study. Each patient was randomly assigned to one of three groups: to receive usual GP care, or to receive usual GP care with one of two cCBT packages.  

Patients were called by a technician on a weekly basis to provide encouragement and support to complete the programmes. 

Each patient's depression and health-related quality of life were assessed at 4, 12 and 24 months. 

Results showed that cCBT offered little or no benefit over usual GP care. By four months, 44% of patients in the usual care group, 50% of patients in the Beating the Blues group, and 49% in the MoodGYM group remained depressed. 

"The main reason for this was low adherence and engagement with treatment, rather than lack of efficacy," explains Chief Investigator, Professor Simon Gilbody.

Computer login records were analysed and showed that 83% of patients assigned to Beating the Blues, and 77% of MoodGYM participants accessed the programmes after allocation. However, only 18% of patients completed all eight sessions of Beating the Blues, and 16% completed all six sessions of MoodGYM. Almost a quarter of patients dropped out of the study by four months. 

Furthermore, the commercially developed Beating the Blues programme offered no benefit over the free-to-use MoodGYM. "This is an important finding for those who commission services and purchase commercial products on behalf of publicly funded health services," commented Professor Gilbody.   

Read the full report in issue 19(101) of Health Technology Assessment.