The role of computer‐aided psychotherapy within an NHS CBT specialist service
Open accessAbstract
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 computer‐aided psychotherapy, which individuals are best suited to using these interventions, and why some users drop out prior to programme completion.
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A study in the United Kingdom found that 19% of participants required referral to a therapist on completion of CCBT.
“A study in the United Kingdom [57] found that 19% of participants required referral to a therapist on completion of CCBT.”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [57]
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ResultGEOGRAPHIC INEQUITY IN THE AVAILABILITY OF COGNITIVE BEHAVIOURAL THERAPY IN ENG LAND AND WALES
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ResultComputer programs for psychotherapy
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ResultAdherence to self-care interventions for depression or anxiety: A systematic review
Simco, R., McCusker, J., & Sewitch, M. J. (2014) · Health Education Journal · doi:10.1177/0017896913514738 · Cited by 19 · see citing works
“All studies reporting direct observation adherence, save Whitfield et al. (2006), also have the same ambiguity as to whether completion or participation was measured; these studies also all offered the same computerised intervention (Grime, 2004; Learmonth et al., 2008; Shapiro et al., 2004).”
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“These self-care technologies (SCTs) draw from a wide range of creative ideas, therapeutic pedagogies and self-help approaches; with projects ranging from computerised cognitive behavioural therapy software[92, 99], mindfulness phone apps[129, 152] to relaxing virtual reality environments[46].”
BackgroundIncreasing engagement with computerised cognitive behavioural therapies
Cavanagh, K., & Millings, A. (2013) · ICST Transactions on Ambient Systems · doi:10.4108/trans.amsys.01-06.2013.e3 · Cited by 15 · see citing works
“, 2010), specialist CBT services (Learmonth et al., 2008), service-user led third sector organisations (Cavanagh, Seccombe, & Lidbetter, 2011) and dedicated e-health services (e.”
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“To place the current data into context, the reliable and clinically significant change benchmarks defined by Westbrook and Kirk (2005) and followed by Cavanagh et al. (2006) and Learmonth et al. (2008) were also used.”
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“Online treatments offer a potentially efficient, cost-effective (Learmonth et al., 2008; Spurgeon and Wright, 2010) flexible, and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demands on services (Jolstedt et al.”
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BackgroundInternetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick
Backenstrass, M., & Wolf, M. (2018) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000339 · Cited by 8 · see citing works
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“Benefits were found for CCBT in a naturalistic, uncontrolled study of eight sessions of CCBT in a specialist CBT centre in the UK (Learmonth et al., 2008).”
BackgroundResultEquivalence-based measures of clinical significance: assessing treatments for depression
Nasiakos, G., Cribbie, R. A., & Arpin-Cribbie, C. A. (2010) · Psychotherapy Research · doi:10.1080/10503307.2010.501039 · Cited by 7 · see citing works
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“Multiple studies support this approach, as it not only potentially makes mental health services accessible for an extensive bandwidth of people, but also applies proven elements of traditional CBT treatment by providing psychoeducation and self-insight on a low threshold level [25–27].”
BackgroundParticipatory medicine: model based tools for engaging and empowering the individual
Sagar, M. A., & Broadbent, E. (2016) · Interface Focus · doi:10.1098/rsfs.2015.0092 · Cited by 7 · see citing works
Training in empirically supported treatments using alternative learning modalities.
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Computerised CBT self‐help for depression in Higher Education: Reflections on a pilot
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“Feasibility studies have extended beyond primary care, with Learmonth, Trosh, Rai, Sewell, and Cavanagh ( 2008 ) reporting evidence for the value of BtB within secondary mental healthcare.”
BackgroundCientanni, F., Power, K., Wright, C., Sani, F., Reilly, D., Blake, M.-L., Hustings, K., Morgan, D., & Clark, S. A. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100248 · Cited by 6 · see citing works
“, 2004), secondary care (Learmonth and Rai, 2008), and specialist care services (Learmonth et al., 2008), as well as in treating those experiencing depression with physical comorbidities such as multiple sclerosis (Cooper et al.”
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“Meta-analyses have found that cCBT for depression and anxiety disorders is similarly effective to traditional face-to-face CBT in reducing symptoms of depression and anxiety [14-16].”
Fournier, V., Talbot, F., Hadjistavropoulos, H. D., Titov, N., Dear, B. F., Lang, R., Saulnier, V., Hébert, H., & Cloutier, G. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100813 · Cited by 3 · see citing works
“…who may be less comfortable with technology, it may be best to give them the option of completing the program in a private room in a mental health setting with a trained administrator on site to help with technical and other tasks such as printing handouts as done by Learmonth et al. (2008).”
Warren, F. A., Day, K., Paton, C., Warren, D., Tds., M., Gu, Y., Adnan, M., & Reedy, W. J. (2010) · ResearchSpace (University of Auckland) · Cited by 3 · see citing works
Carreira, M., de Adana, M. S. R., Pinzón, J. L., & Ortiz, M. T. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274551 · Cited by 3 · see citing works
“Two pioneering platforms for the general population that have obtained positive results are MoodGYM and Beating the Blues [23, 24].”
BackgroundBDI-II: Self-Report and Interview-based Administration Yield the Same Results in Young Adults
Gottfried, J., Chvojka, E., Klocek, A., Kratochvil, T., Palíšek, P., & Tancoš, M. (2024) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-024-10154-z · Cited by 2 · see citing works
“This effect has practical implications because people are often asked to fill out BDI-II multiple times in order to monitor their progress in therapy (Learmonth et al., 2008) or as a follow-up measure after finished treatment (Lemmens et al., 2019).”
Socialization or Social Isolation?
Heyes, K. (2017) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-5225-2958-3.ch002 · Cited by 1 · see citing works
“Despite a paucity of research showing completion rates of professional online therapeutic support interventions are rare (Simco et al., 2014), those that do complete the set programmes have been found to benefit from the support (Learmonth et al., 2008).”
BackgroundBerman, M. I., Buckey, J. C., Hull, J. G., Linardatos, E., Song, S. L., Cartreine, J. A., McLellan, R. K., & Hegel, M. T. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.12.008
Hunkeler, E. M., Hargreaves, A. D., Meresman, J. F., Lee, J., Simon, G. E., & Bauer, S. (2012)
Unegv, D. A. P. S. W. A., Hughes, M., Maher, N., Shen, Y., Shore-Fitzgerald, C., & Wang, Y. (2017) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2017.1367303
User experiences of online community support for mental ill health
Heyes, K. (2026) · e-space (Manchester Metropolitan University) · doi:10.83056/mmu.32479590
Socialization or Social Isolation?
Heyes, K. (2021) · IGI Global eBooks · doi:10.4018/978-1-7998-8544-3.ch021
Dropping out from cCBT: An investigation of non-completion of beating the blues
Johnson, S., & Hinshaw, T. (2011) · Clinical Psychology Forum · doi:10.53841/bpscpf.2011.1.227.22
John, S., & Singh, K. K. (2026) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-026-00736-x
Clinicians' views of computer-guided CBT in adult mental health and factors related to referrals
Varley, M. C. (2011) · ERA
Online Support Groups and Therapy
Harwood, T. M., & L’Abate, L. (2009) · Springer eBooks · doi:10.1007/978-1-4419-1099-8_5
- Authors
- Learmonth, D., Trosh, J., Rai, S., Sewell, J., & Cavanagh, K.
- Affiliations
- City, University of London (GB)
- CBT Department Chelmsford and Essex Centre Chelmsford UK
- Independent research consultant Newcastle UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- Corresponding author
- Learmonth, Despina
- ORCID
- Cavanagh, Kate
- Venue
- Counselling and Psychotherapy Research
- Publisher
- Wiley
- Published
- 2008-05-07
- Volume
- 8
- Issue
- 2
- Pages
- 117-123
- ISSN
- 1473-3145 (ISSN-L)
- 1746-1405
- OpenAlex
- W2164641243
- Cited by
- 65
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2022: 5 · 2021: 3 · 2020: 1 · 2019: 2 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 8 · 2012: 8
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- Counselling and Psychotherapy Research (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- self-help programs, anxiety, depression, treatment completion, treatment discontinuation, treatment outcomes
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