Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial

BACKGROUND: Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS: To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD: Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. RESULTS: No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. CONCLUSIONS: Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depressio

Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome

BACKGROUND: In a recent randomized trial, we were unable to confirm the previously reported high effectiveness of CCBT. Therefore, the aim of the current study was to have a closer look at usage and acceptability (i.e. expectancy, credibility, and satisfaction) of the intervention. METHODS: Depressed participants (N=200) were given login codes for unsupported online CCBT. A track-and-trace system tracked which components were used. We used a 9-month follow-up period. RESULTS: Uptake was sufficient, but dropout was high. Many usage indices were positively associated with short-term depressive improvement, whereas only homework was related to long-term improvement. Acceptability was good and expectancy could predict long-term, but not short-term outcome. LIMITATIONS: Associations between use of CCBT and improvement are merely correlational. Our sample was too depressed in relation to the scope of the intervention. We relied on online self-report measures. Analyses were exploratory in nature. CONCLUSIONS: Although CCBT might be a feasible and acceptable treatment for depression, means to improve treatment adherence are needed for moderately to severely depressed individual

The responsiveness of quality of life utilities to change in depression: a comparison of instruments (SF-6D, EQ-5D, and DFD)

AbstractBackgroundUtilities are often a main outcome parameter in economic evaluations. Because depression has a large influence on quality of life, it is expected that utilities are responsive to changes in depression.ObjectiveTo evaluate the change in utility derived from different instruments in depression, including the Short Form 6D (SF-6D), the Euroqol based on the UK (EQ-5DUK), the Euroqol based on the Dutch tariff (EQ-5DNL), and utilities derived from Beck Depression Inventory Second Edition (BDI-II) using the Depression-Free-Day method.MethodThis study evaluated the responsiveness, the minimally important difference, and the agreement in utility change derived from the different instruments.ResultsThe SF-6D, EQ-5DUK, and EQ-5DNL were responsive. The minimally important difference values are in line with previous studies, about 0.3. The Depression-Free-Day method nearly always resulted in positive utility changes, even for subgroups that had no change or deterioration in health status or depression. There was poor agreement between utility changes of the SF-6D, EQ-5D (either EQ-5DUK or EQ-5DNL), and DFDu.ConclusionsThe SF-6D, EQ-5DUK, and EQ-5DNL seem responsive and thus adequate for estimating utility in depression treatment. We do not recommend the use of the Depression-Fee-Day method. The low agreement between utility changes indicates that outcomes of the different instruments are incomparable

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

Background: Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. Aims: To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. Method: Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. Results: The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. Conclusion: The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT

One-year follow-up results of unsupported online computerized cognitive behavioural therapy for depression in primary care: A randomized trial

TAU. Overall effects are modest in all interventions, which can be explained by the finding that the use of health care services decreases despite the lack of substantial improvements

Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: a randomised trial

Background Evidence about the cost-effectiveness and cost utility of computerised cognitive-behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study Is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). Aims To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU. Method Costs, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses. Results Costs were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT. conclusions On balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life