Cognitive behavioral therapy (CBT) delivered by a trained therapist is considered to be a highly effective “talking treatment” for depression.
Therapy availability, however, is often an issue. One alternative is the delivery of CBT via specially-designed computer programs which can be used to increase access.
To judge the effectiveness of computerized CBT, Professor Simon Gilbody from York University’s Department of Health Sciences and colleagues performed a large randomized control evaluation named the REEACT trial.
The trial, which included 691 patients with depression carefully selected from 83 general practices across England, is the largest to date to assess the effectiveness of cCBT when added to usual GP care.
Study results showed that cCBT offered little or no benefit over usual GP care with the findings published in the British Medical Journal (BMJ).
Researchers discovered patients generally did not engage with computer programs on a sustained basis. They believe this highlights the difficulties of repeatedly logging on to computer systems when clinically depressed.
Dr Elizabeth Littlewood, who managed the REEACT trial, said, “Current NICE (national) guidelines recommend the use of cCBT as a treatment for depression, but there was a need to carry out a large trial to judge the value of these treatments as they are offered in the NHS.
“Our findings show that cCBT is likely to be an ineffective form of low-intensity treatment for depression and an inefficient use of finite healthcare resources.
“Despite the high level of technical support and weekly encouragement to use the computer packages, there was general low adherence and engagement with this form of treatment. It seems that participants often want more clinical support in addition to therapy.”
Professor Gilbody, added, “These findings have important implications for those who commission services and purchase commercial products on behalf of publicly funded health services. Depression is a treatable condition and there a number of effective interventions that can be offered.
We know that CBT works very well for depression but this research make us less sure that it can be treated when computers alone are used to deliver this treatment.”