Computer-assisted cognitive behavioural therapy (cCBT) is likely to be ineffective in the treatment of depression because of low patient adherence and engagement, suggests the largest study of its kind.
Current guidelines from the National Institute for Health and Care Excellence recommend cCBT as a treatment for depression.
However, in light of their findings, the researchers called for the routine promotion and commissioning of cCBT to be “reconsidered”.
“Participants wanted a greater level of clinical support as an adjunct to therapy”
Cognitive behavioural therapy is considered an effective “talking treatment” for depression, but is not always immediately available in the NHS and cCBT has recently been adopted to boost access.
But it was previously unknown how effective cCBT is for patients with depression in a primary care setting, where most depression is managed. In addition, the two most widely used cCBT programmes have not been compared before.
A team of researchers from the University of York carried out a randomised trial to assess the effectiveness of cCBT when added to usual GP care, and compare two commonly-used packages.
In total, 691 patients with depression from 83 general practices across several locations in England were enrolled in the REEACT study.
Each patient was randomised to one of three groups – to receive usual GP care, or to receive usual GP care with one of two cCBT packages.
The cCBT packages used were Beating the Blues and MoodGYM. They consisted of eight and six one-hour sessions, respectively, and both encouraged homework between sessions.
Each patient’s depression and health-related quality of life were assessed at four, 12 and 24 months.
Results showed that cCBT offered little or no benefit over usual GP care. 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.
“The main reason for this was low adherence and engagement with treatment, rather than lack of efficacy,” said the study authors in the British Medical Journal.
“Guided self help is not the panacea that busy GPs and cost conscious clinical commissioning groups would wish for”
Computer login records were analysed and showed that 83% of patients assigned to Beating the Blues, and 77% of MoodGYM participants accessed the programmes after allocation.
However, only 18% of patients completed all eight sessions of Beating the Blues, and 16% completed all six sessions of MoodGYM. Almost a quarter of patients dropped out of the study by four months.
The study 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,” said the authors.
In addition, the researchers said the commercially-available Beating the Blues programme was found to offer no benefit over MoodGYM, which is free to use.
Commenting on the findings, Professor Christopher Dowrick from Liverpool University said the evidence from the trial was “not in itself sufficient to overturn existing guidelines”, but the findings did have “important implications”.
He argued that many depressed patients preferred to “interact with human beings” and that guided self-help is “not the panacea” that cost-conscious clinical commissioning groups “would wish for”.