Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial

Background Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care. Aims To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables. Method A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBTor treatment as usual, with follow-up assessment at 6 months. Results The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment. Conclusions Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.

[1]  Martin E. P. Seligman,et al.  The attributional Style Questionnaire , 1982, Cognitive Therapy and Research.

[2]  Martin Knapp,et al.  Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial , 2004, British Journal of Psychiatry.

[3]  K. Cavanagh,et al.  Geographic inequity in the availability of cognitive behavioural therapy in England and Wales , 2003 .

[4]  B. Everitt,et al.  Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice , 2003, Psychological Medicine.

[5]  Debashis Ghosh,et al.  Statistical Aspects of the Design and Analysis of Clinical Trials , 2002 .

[6]  J. Mundt,et al.  The Work and Social Adjustment Scale: a simple measure of impairment in functioning. , 2002, The British journal of psychiatry : the journal of mental science.

[7]  Christopher Williams,et al.  A UNITED KINGDOM SURVEY OF ACCRED ITED COGNITIVE BEHAVIOUR THERAPISTS' ATTITUDES TOWARDS AND USE OF STRUCTURED SELF-HELP MATERIALS , 2002, Behavioural and Cognitive Psychotherapy.

[8]  D. Bates,et al.  Mixed-Effects Models in S and S-PLUS , 2001 .

[9]  A. Tylee.  Major depressive disorder (MDD) from the patient's perspective: overcoming barriers to appropriate care , 2001, International journal of psychiatry in clinical practice.

[10]  K. Lovell,et al.  MULTIPLE ACCESS POINTS AND LEVELS OF ENTRY (MAPLE): ENSURING CHOICE, ACCESSIBILITY AND EQUITY FOR CBT SERVICES , 2000 .

[11]  T. B. Ustün.  The global burden of mental disorders. , 1999, American journal of public health.

[12]  R. DeRubeis,et al.  Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. , 1999, The American journal of psychiatry.

[13]  S. Checkley.  The management of depression , 1998 .

[14]  Graham Dunn,et al.  Effect of cognitive-behavioural training on job-finding among long-term unemployed people , 1997, The Lancet.

[15]  L. Mynors-Wallis,et al.  Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care , 1995, BMJ.

[16]  Gordon Higginson,et al.  Clinical Standards Advisory Group , 1994, Quality in health care : QHC.

[17]  G. Lewis,et al.  Assessing psychiatric disorder with a human interviewer or a computer. , 1994, Journal of epidemiology and community health.

[18]  R. Muñoz,et al.  Intervention for minor depression in primary care patients. , 1994, Psychosomatic medicine.

[19]  P M Higgins,et al.  COGNITIVE BEHAVIOUR THERAPY FOR PSYCHIATRIC PROBLEMS , 1990 .

[20]  M. Seligman,et al.  Explanatory style change during cognitive therapy for unipolar depression. , 1988, Journal of abnormal psychology.

[21]  R. Lévy.  The detection of psychiatric illness by questionnaire , 1973 .

[22]  D. Goldberg.  The detection of psychiatric illness by questionnaire : a technique for the identification and assessment of non-psychotic psychiatric illness , 1972 .