Researchers found low patient adherence and engagement with computer-assisted cognitive behavioural therapy programmes.
The benefits of computer-assisted cognitive behavioural therapy for tackling depression have been called in to question by a study that found low patient adherence and engagement with the treatment.
Computer-assisted CBT (cCBT) is endorsed by the National Institute for Health and Care Excellence (Nice), and has been seen as a way of boosting access to talking therapies, for which patients often face lengthy waits.
But an independent study by University of York researchers found that people who received usual GP care with one of two cCBT packages experienced no additional improvement in depression after four months, compared with those who solely received usual GP care.
The results, published in the BMJ on Wednesday, led the authors to conclude that promotion and commissioning of cCBT should be reconsidered, because it is “likely to be an ineffective form of low-intensity treatment for depression and an inefficient use of finite healthcare resources”.
“Participants said they wanted a greater level of clinical support as an adjunct to therapy, and, in the absence of this support, they commonly disengaged with the computer programmes.”
The REEACT study, believed to be the largest of its kind, involved 691 patients with depression from 83 GP surgeries across England, who were randomly assigned into one of three groups – to have solely GP care, or to receive it with one of two cCBT packages.
The cCBT packages were two of the most popular available, the commercialBeating the Blues, developed by King’s College London’s (KCL’s) Institute of Psychiatry, and the Australian National University’s (ANU’s) free-to-useMoodGYM.
Developer-led trials of both have shown them to be efficacious in reducing symptoms of depression. But the REEACT researchers wanted to test their impact with a level of support akin to that typically offered in an NHS primary care setting.
Participants were called by a technician on a weekly basis to provide encouragement and support to complete the programmes, which consist of eight (Beating the Blues) and six (MoodGYM) one-hour sessions respectively.
Each patient’s depression and health-related quality of life were assessed at four, 12 and 24 months.
By four months, 44% of participants in the usual care group, 50% of patients in the Beating the Blues group and 49% in the MoodGYM group remained depressed.
The authors write: “The main reason for this was low adherence and engagement with treatment, rather than lack of efficacy.”
Computer login records showed that while 83% of patients assigned to Beating the Blues, and 77% of MoodGYM participants accessed the programmes after allocation, only 18% and 16% respectively completed the full course. Almost a quarter of patients dropped out of the study by four months.
The only statistical evidence of a difference was in favour of MoodGYM versus usual GP care at 12 months but this was no longer evident at 24 months.
A Nice spokeswoman said: “We recommend computerised CBT as one option for treating people with mild to moderate depression, but the decision to offer it should always be based on clinical judgement and the patient’s preference. If it is deemed appropriate, we recommend it is supported by a trained practitioner who reviews the patient’s progress and their outcome.
“We are currently updating our guidance for the treatment and management of depression in adults. We will take all published evidence into consideration.”
KCL said most of the research team who worked on Beating the Blues had left and so declined to comment. ANU could not be reached for comment before publication.
Courtesy: The Guardian