Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice

Background. Cognitive-behavioural therapy (CBT) brings about significant clinical improvement in anxiety and depression, but therapists are in short supply. We report the first phase of a randomized controlled trial of an interactive multimedia program of cognitive-behavioural techniques, Beating the Blues™ (BtB), in the treatment of patients in general practice with anxiety, depression or mixed anxiety/depression. Method. One hundred and sixty-seven adults suffering from anxiety and/or depression and not receiving any form of psychological treatment or counselling were randomly allocated to receive, with or without medication, BtB or treatment as usual (TAU). Measures were taken on five occasions: prior to treatment, 2 months later, and at 1, 3 and 6 months follow-up using the Beck Depression Inventory, Beck Anxiety Inventory and Work and Social Adjustment Scale. Results. Patients who received BtB showed significantly greater improvement in depression and anxiety compared to TAU by the end of treatment (2 months) and to 6 months follow-up. Symptom reduction was paralleled by improvement in work and social adjustment. There were no interactions of BtB with concomitant pharmacotherapy or duration of illness, but evidence, on the Beck Anxiety Inventory only, of interaction with primary care practice. Importantly, there was no interaction between the effects of BtB and baseline severity of depression, from which we conclude that the effects of the computer program are independent of starting level of depression. Conclusions. These results demonstrate that computerized interactive multimedia cognitive-behavioural techniques under minimal clinical supervision can bring about improvements in depression and anxiety, as well as in work and social adjustment, with and without pharmacotherapy and in patients with pre-treatment illness of durations greater or less than 6 months. Thus, our results indicate that wider dissemination of cognitive-behavioural techniques is possible for patients suffering from anxiety and/or depression.

[1]  S. Newman.  Modern Medical Statistics. A Practical Guide. , 2004 .

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

[3]  V. Carey,et al.  Mixed-Effects Models in S and S-Plus , 2001 .

[4]  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.

[5]  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.

[6]  I. Blackburn,et al.  A meta-analysis of the effects of cognitive therapy in depressed patients. , 1998, Journal of affective disorders.

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

[8]  Alan D. Lopez,et al.  Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study , 1997, The Lancet.

[9]  W. Stiles,et al.  Outcomes of time-limited psychotherapy in applied settings: replicating the Second Sheffield Psychotherapy Project. , 1996, Journal of consulting and clinical psychology.

[10]  W. Katon,et al.  Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs tricyclic antidepressants. , 1996, JAMA.

[11]  M. Barkham,et al.  Effects of treatment duration and severity of depression on the maintenance of gains after cognitive-behavioral and psychodynamic-interpersonal psychotherapy. , 1995, Journal of consulting and clinical psychology.

[12]  M. Barkham,et al.  Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. , 1994, Journal of consulting and clinical psychology.

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

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

[15]  P. Lelliott,et al.  Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia , 1993, British Journal of Psychiatry.

[16]  S. Hollon,et al.  Cognitive therapy and pharmacotherapy for depression. , 1990, Journal of consulting and clinical psychology.

[17]  S Senn,et al.  Analysis of serial measurements in medical research. , 1990, BMJ.

[18]  J. Greist,et al.  Computer-administered cognitive-behavioral therapy for depression. , 1990, The American journal of psychiatry.

[19]  S D Imber,et al.  National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. , 1989, Archives of general psychiatry.

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

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