Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: A qualitative study on patient experiences

Gerhards, S.A.H.; Abma, Tineke; Arntz, Arnoud; Graaf, L. Esther de; Evers, Silvia M. A. A.; Huibers, Marcus J.H.; Widdershoven, Guy

doi:10.1016/j.jad.2010.09.012

Cited by 132 publications

(164 citation statements)

References 27 publications

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“…366 Barriers to the use of online CBT include participants' lack of identification with the applicability of CBT to their difficulties and problems using computers. 367 Several authors have suggested that internet-based therapy for mental health problems might be more effective if accompanied by low-intensity remote therapist support by telephone, e-mail or messaging. 79,367,368 In the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT)2 study, a follow-on trial to the negative REEACT trial of computerised CBT packages described above, Gilbody et al have found that computerised CBT accompanied by telephone support is more effective than computerised CBT alone (S Gilbody, Hull York Medical School, University of York, 8 July 2015, personal communication).…”

Section: Computerised Cognitive-behavioural Therapymentioning

confidence: 99%

“…413 This has been the case for broad-based interventions such as the WSD programme 398 as well as studies of specific technologies such as computerised CBT. 367 The limited effectiveness of the Healthlines Service is disappointing, given that some of the specific interventions (such as telemonitoring for blood pressure, 148,150 referrals to text-based smoking cessation programmes 160 or computerised CBT 414 ) that it incorporated have had more positive results in earlier studies. There are several possible explanations for this finding.…”

Section: Relation To Previous Studiesmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Computerised Cognitive-behavioural Therapymentioning

confidence: 99%

Section: Relation To Previous Studiesmentioning

confidence: 99%

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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“…Furthermore, PRPs highlighted the psychological and emotional demands of taking part in the PAR process. However, having received CBT within our previous research [11, 12, example, the inclusion of patient vignettes to facilitate normalisation [20] and enhance identification with the intervention content [21]. Further, PRPs' concerns regarding limitations of not being able to personalise the content of the intervention are consistent with wider research [14].…”

Section: Process Evaluationmentioning

confidence: 71%

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach (Preprint)

Wikman¹,

Kukkola²,

Börjesson³

et al. 2017

Preprint

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“…Hierzu zählen etwa frei verfügbare Zeit oder soziale Unterstützung aus dem näheren Umfeld (Gerhards et al 2011;Donkin und Glozier 2012;Farrer et al 2013). In manchen Studien stehen Faktoren wie Therapiemotivation, Erfolgserwartungen sowie strukturiertes und diszipliniertes Arbeiten mit positiven Ergebnissen im Zusammenhang (Donkin und Glozier 2012;Ebert et al 2013a;Bendelin et al 2011).…”

Section: E-mental Health · Blended Therapy · Online Intervention · Psunclassified

Computer and psychotherapy – do they fit?

2017

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Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: A qualitative study on patient experiences

Cited by 132 publications

References 27 publications

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach (Preprint)

Computer and psychotherapy – do they fit?

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