When treating depression, computer-assisted cognitive behavioral therapy (CBT) is ineffective primarily due to patient disinterest, suggests a team of English academic researchers. Their new study is the largest to date.

Cognitive behavior therapy (CBT) is not only a popular form of treatment for depression, but its efficacy is supported by scientific studies, explain the researchers in the introduction to their study. Naturally, demand is high for CBT, yet the United Kingdom’s National Health Service has too few therapists to offer services for each and every patient seeking help. To address this unmet need, the National Institute for Health and Care Excellence guidelines recommend computerized CBT (known as cCBT) as a first step in a ladder treatment approach.

“If effective, such programs have the potential to expand access to psychological therapy in primary care and could represent an efficient non-pharmacological intervention for depression or adjunct to pharmacological treatments,” wrote the authors, who hail from University of York, University of Sheffield, University of Cambridge, University of Hull, University of Birmingham, University of Manchester, and University of Exeter.

So just one question remains: Will a computerized version of CBT help patients suffering from depression as much as in-person CBT?

Value Assessment

The researchers designed an experiment to evaluate cCBT, while also comparing two commonly used computerized CBT programs. In total, 691 patients with depression were recruited into the Randomized Evaluation of the Effectiveness and Acceptability of Computerized Therapy (REEACT) study. Randomly assigned to one of three groups, each patient received either usual general practitioner (GP) care, or usual GP care with one of two cCBT programs, either the commercial “Beating the Blues” or the freely available “MoodGYM,” which consist of eight and six one-hour sessions respectively. (If you would like to access freely-available MoodGYM, click here.) Both programs encourage homework between sessions.

Though random, the three-patient groups were nicely balanced with regard to age, sex, severity of depression, educational background, and use of antidepressants, the researchers say. And, as part of the study, a technician called patients on a weekly basis to encourage completion of the computerized programs. At four, 12, and 24 months, the researchers assessed each patient's depression and health-related quality of life.

By four months, 44 percent of patients in the usual care group, 50 percent in the Beating the Blues group, and 49 percent in the MoodGYM group remained depressed, the researchers discovered. The electronic records revealed only 18 percent of patients had completed all the sessions of Beating the Blues, while just 16 percent had completed MoodGYM. In fact, nearly a quarter of patients had dropped out by four months.

The authors concluded cCBT confers little to no benefit to depressed patients, adding that “commercially developed computerized cognitive behavior therapy products confer little or no benefit over free-to-use products.” (Good news for anyone whose job is to commission products on behalf of public health services.) These negative results, the research team explained, are most likely caused by a "lack of uptake," even when telephone support had been provided. Since many people need help, they suggest further study of alternatives to cCBT, including bibliotherapy, telephone guided self-help, and social worker-supported self-help technologies.

Source: Gilbody S, Littlewood E, Hewitt C, et al. Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. BMJ. 2015.