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Commissioning computer-based CBT unlikely to help depression


13 November 2015

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Computerised cognitive behavioural therapy (cCBT) is likely to be ineffective as a treatment for depression, due to low adherence and engagement with the programme, according to a new study.

Computerised cognitive behavioural therapy (cCBT) is likely to be ineffective as a treatment for depression, due to low adherence and engagement with the programme, according to a new study.

CBT is considered an effective "talking treatment" for depression, but is not always immediately available in the NHS so cCBT has recently been developed to increase access to this form of treatment.

While current NICE guidelines recommend cCBT as a treatment for depression, the study – of 691 patients with depression from 83 general practices in England – found that the package “offered little or no benefit over usual GP care”.

The study, published in the British Medical Journal (BMJ), found that patients were “generally unwilling to engage with computer programmes, and highlighted the difficulty in repeatedly logging on to computer systems when clinically depressed… Participants wanted a greater level of clinical support as an adjunct to therapy, and in absence of this support, they commonly disengaged with the computer programmes,”

The packages used were the commercial "Beating the Blues" and the free-to-use "MoodGYM", consisting of eight and six 1 hour sessions respectively, and both encouraged homework between sessions (eg, patients were called weekly by a technician on a weekly basis to provide encouragement).

Patients were assessed at four, 12 and 24 months, and 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. After four months participants began to disengage with the programmes.

Professor Christopher Dowrick at the University of Liverpool said the evidence from this trial “is not in itself sufficient to overturn existing guidelines” but the findings “do have important implications.” 
He argued that many depressed patients “do not want to engage with computers, they prefer to interact with human beings" and believes the lack of patient engagement “suggests that guided self help is not the panacea that busy GPs and cost conscious clinical commissioning groups would wish for".

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