Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

Background Computerised cognitive–behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. Aims To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. Method Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. Results No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. Conclusions Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

[1]  Ware J.E.Jr.,et al.  THE MOS 36- ITEM SHORT FORM HEALTH SURVEY (SF- 36) CONCEPTUAL FRAMEWORK AND ITEM SELECTION , 1992 .

[2]  P. S. Achilles.  THE PSYCHOLOGICAL CORPORATION. , 1923, Science.

[3]  C. Taylor,et al.  A Palmtop Computer Program for the Treatment of Generalized Anxiety Disorder , 1999, Behavior modification.

[4]  J. Butcher,et al.  Validity and utility of computer-based test interpretation. , 2000, Psychological assessment.

[5]  A. Beck,et al.  The empirical status of cognitive-behavioral therapy: a review of meta-analyses. , 2006, Clinical psychology review.

[6]  R. Sysko,et al.  Placebo response in studies of major depression: variable, substantial, and growing. , 2002, JAMA.

[7]  A. Ravindran,et al.  A comparison of placebo responders and nonresponders in subgroups of depressive disorder. , 1995, Journal of psychiatry & neuroscience : JPN.

[8]  W. Katon,et al.  Collaborative management to achieve treatment guidelines. Impact on depression in primary care. , 1995, JAMA.

[9]  L. Hooper,et al.  Zout en bloeddruk , 2003 .

[10]  HighWire Press,et al.  The British Journal of Psychiatry , 2006, British Journal of Psychiatry.

[11]  S. Hollon,et al.  Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. , 2006, Annual review of psychology.

[12]  I. Miller,et al.  Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. , 2001, Journal of affective disorders.

[13]  N. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991, Journal of consulting and clinical psychology.

[14]  S STEFANE.,et al.  Equivalence of Computerized and Conventional Versions of the Beck Depression Inventory . II ( BDI-II ) , 2022 .

[15]  K R Abrams,et al.  Systematic review and evaluation of methods of assessing urinary incontinence. , 2006, Health technology assessment.

[16]  R G Priest,et al.  The Defeat Depression Campaign: psychiatry in the public arena. , 1997, The American journal of psychiatry.

[17]  Anne Marie Albano,et al.  Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. , 2005, The American journal of psychiatry.

[18]  P. Manzo,et al.  Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open U.S.-U.K. study. , 1998, The Journal of clinical psychiatry.

[19]  I. Marks,et al.  Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial. , 2005, Journal of clinical psychology.

[20]  G. Andersson,et al.  Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support , 2007, British Journal of Psychiatry.

[21]  P. Cuijpers,et al.  Minimal-contact psychotherapy for sub-threshold depression in primary care , 2004, British Journal of Psychiatry.

[22]  D. Sackett,et al.  The number needed to treat: a clinically useful measure of treatment effect , 1995, BMJ.

[23]  Kate Cavanagh,et al.  Computer treatment for common mental health problems. , 2004, Journal of clinical psychology.

[24]  Scott B Patten,et al.  Prevention of depressive symptoms through the use of distance technologies. , 2003, Psychiatric services.

[25]  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.

[26]  F. Scogin,et al.  Self-administered treatment in stepped-care models of depression treatment. , 2003, Journal of clinical psychology.

[27]  N. Aaronson,et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. , 1998, Journal of clinical epidemiology.

[28]  R. Bijl,et al.  Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) , 1998, Social Psychiatry and Psychiatric Epidemiology.

[29]  David C. Atkins,et al.  Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. , 2006, Journal of consulting and clinical psychology.

[30]  L. Derogatis,et al.  The SCL-90 and the MMPI: A Step in the Validation of a New Self-Report Scale , 1976, British Journal of Psychiatry.

[31]  P. Lewinsohn,et al.  The Coping With Depression Course: A Group Psychoeducational Intervention for Unipolar Depression , 1984, Behaviour Change.

[32]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[33]  Olga V. Demler,et al.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). , 2003, JAMA.

[34]  A. Beck,et al.  Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. , 1996, Journal of personality assessment.

[35]  J. Larson.  The MOS 36-Item Short form Health Survey , 1997, Evaluation & the health professions.

[36]  Chris Kelleher,et al.  Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders , 2005, Journal of medical Internet research.

[37]  P. Cuijpers,et al.  One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years , 2008, Psychological Medicine.

[38]  K. Dobson,et al.  Cognitive therapy of depression: pretreatment patient predictors of outcome. , 2002, Clinical psychology review.

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

[40]  G. Andersson,et al.  Pros and cons of online cognitive–behavioural therapy , 2008, British Journal of Psychiatry.

[41]  B. Everitt,et al.  Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial , 2004, British Journal of Psychiatry.

[42]  F. Lynch,et al.  Overcoming Depression on the Internet (ODIN): A Randomized Controlled Trial of an Internet Depression Skills Intervention Program , 2002, Journal of medical Internet research.

[43]  P Sutcliffe,et al.  Health technology assessment. , 1986, Israel journal of medical sciences.

[44]  H. Rytsälä,et al.  Do characteristics of patients with major depressive disorder differ between primary and psychiatric care? , 2007, Psychological Medicine.

[45]  Heleen Riper,et al.  Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial , 2007, Psychological Medicine.

[46]  H. Riper,et al.  Bmc Public Health Clinical and Cost-effectiveness of Computerised Cognitive Behavioural Therapy for Depression in Primary Care: Design of a Randomised Trial , 2008 .

[47]  Randolph C. Arnau,et al.  Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. , 2001, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[48]  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.

[49]  H. Christensen,et al.  Delivering interventions for depression by using the internet: randomised controlled trial , 2004, BMJ : British Medical Journal.

[50]  M. Thase,et al.  The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. , 1997, JAMA.

[51]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[52]  G. Andersson,et al.  Internet-based self-help for depression: randomised controlled trial , 2005, British Journal of Psychiatry.

[53]  E. Kaltenthaler,et al.  The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review , 2008, Psychological Medicine.

[54]  A. Farmer,et al.  The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. , 1988, Archives of general psychiatry.

[55]  J. Butcher,et al.  Computers in clinical assessment: historical developments, present status, and future challenges. , 2004, Journal of clinical psychology.

[56]  이동우.  한국어판 Composite International Diagnostic Interview의 타당도 , 2003 .

[57]  A. Weissman.  The Dysfunctional Attitude Scale: A Validation Study , 1979 .

[58]  R. DeRubeis,et al.  Cognitive therapy vs medications in the treatment of moderate to severe depression. , 2005, Archives of general psychiatry.

[59]  Heleen Riper,et al.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis , 2006, Psychological Medicine.