The role of computer‐aided psychotherapy within an NHS CBT specialist service

Abstract

To date, the feasibility of computer-aided psychotherapy as an intervention has only been recognised in primary care practice. The present study sought to evaluate the impact of 'Beating the Blues' (BtB), an established computerised cognitive behaviour therapy (CCBT) self-help programme for the management of anxiety and depression, within an NHS CBT specialist healthcare centre. Of the 555 service users who used BtB as part of routine care, with follow-up assessment at six to eight weeks, 71% completed all eight sessions. Statistically significant differences on the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were found in completer and intention-to-treat analyses; 50% of completers achieved reliable change on the BDI-II and approximately 25% of completers achieved reliable and clinically significant change on both measures. Outcomes were benchmarked against outcomes in studies of routine face-to-face CBT. These findings provide evidence that BtB may be of value to service users in secondary mental healthcare centres, alleviating current burdens on public health and therapeutic resources. Future research directions should include examining which factors influence individuals' decisions to try computeraided psychotherapy, which individuals are best suited to using these interventions, and why some users drop out prior to programme completion.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…Five of the papers reported uncontrolled before-and-after studies, [265][266][267][268][269] only one included a (non-randomised) historical control. 270 Study quality was poor (range 15-18), failings being due to lack of information on intervention (n = 3), description of principal confounders (n = 6) and whether or not treatment was representative of treatment the majority of patients received (n = 6).…”

“…270 All the studies dealt with strategies for implementing CBT but in different settings: two specialist CBT centres, 267,268 one private psychiatric hospital 270 and three community-based clinics. 265,266,269 Quality assessment and weighting of the evidence…”

“…All studies reported improved depression and anxiety post intervention, both in terms of changes in mean score greater than the defined clinically important difference and in the proportion of people who improved during the course. [265][266][267][268][269] At the end of the course, approximately one in five of those who completed the cCBT were referred on to face-to-face therapy. 268 Authors concluded that offering cCBT as a first step was an effective way to manage demand, 265,267,268 provide timely access to therapy 269 and could be supported by volunteer support workers (as opposed to mental health professionals).…”

“…problem diaries, thought records, behavioural experiments). 265,[267][268][269] Trained mental health workers were available to support the cCBT and to assess progress at the end of each session, alerting senior therapists in the event of concerns (e.g. suicide risk).…”

“…Six implementation studies were included for depression (see Table 121 for details): five from the UK, [265][266][267][268][269] and one from Australia. 270 All the studies dealt with strategies for implementing CBT but in different settings: two specialist CBT centres, 267,268 one private psychiatric hospital 270 and three community-based clinics.…”