It's Worth a Try: The Treatment Experiences of Rural and Urban Participants in a Randomized Controlled Trial of Computerized Psychological Treatment for Comorbid Depression and Alcohol/Other Drug Use
Open accessAbstract
Objective: To examine clinician-assisted computerized psychological treatment for depression and alcohol/other drug use comorbidity in rural and urban communities. Methods: Participants in an Australian randomized controlled clinical trial who completed the 3-month post-baseline assessment were examined (n = 163), including those from remote/outer regional (n = 16, 10%) and inner regional (n = 37, 23%) areas and major cities (n = 110, 67%). Participants were using alcohol and/or cannabis at hazardous levels in the month prior to baseline and concurrently reported at least moderate levels of depression. Following provision of the first treatment session (conducted face-to-face for all conditions), participants were randomized to: (1) nine further face-to-face sessions of combination cognitive behavioral therapy and motivational interviewing; (2) nine sessions of combination cognitive behavioral therapy and motivational interviewing delivered via computer, with brief clinician assistance; or (3) nine sessions of supportive counseling. Blind, independent follow-up occurred at 3 months post-baseline. Changes in depression, alcohol, and cannabis use at 3 months post-baseline were the outcomes of interest, with rurality, treatment allocation, and treatment preference fulfilment as independent variables. Self-reported helpfulness and experience of treatment was also explored. Results: Participants completing the 3-month post-baseline assessment (n = 163) were significantly older than those who did not (n = 111) and attended significantly more treatment sessions. The outcomes of interest, including helpfulness of treatment, were not significantly associated with rurality. Of the 92 participants indicating a treatment preference prior to randomization, 13 (14%) nominated a preference for computer-delivered treatment. However, treatment preference did not affect retention, therapeutic alliance, or the benefits reported by urban and rural participants in the trial receiving computerized treatment. Computerized treatment was associated with significantly greater reductions in alcohol use relative to face-to-face cognitive behavioral therapy/motivational interviewing (d = 0.621) and supportive counseling (d = 0.904). Conclusions: Computer-delivered cognitive behavioral therapy and motivational interviewing (with clinical assistance) is an efficacious treatment for depressive and addictive disorders, with similar levels of acceptability and benefit in rural and urban participants. Computerized psychological treatment might be an acceptable treatment for underserviced populations, with real potential to bridge service gaps and to overcome isolation and perceived stigma among isolated communities. This clinical trial is registered with the Australian New Zealand Clinical Trials Registry as trial #ACTRN12610000274077 (http://www.anzctr.org.au/trial_view.aspx?id=335314).
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Kay-Lambkin and colleagues found that rurality did not affect retention.
“Kay-Lambkin and colleagues found that rurality did not affect retention [41].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
The Retention section reports no main effect of rurality on sessions attended, supporting the claim in that limited sense. It also reports a significant interaction involving rurality, treatment allocation, and preference fulfilment, so the unqualified statement that rurality did not affect retention overstates the finding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAcceptability increases significantly once patients have received a demonstration or have undertaken the treatment.
“Acceptability increases significantly once patients have received a demonstration or have undertaken the treatment [19,41,49,52].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
The Abstract reports that only 13 of 92 participants who expressed a preference before randomization preferred computer-delivered treatment. The Conclusions and ‘The Potential of Computerized Psychological Treatment for Comorbidity’ say the treatment was acceptable to participants, including those who had preferred face-to-face therapy. The paper does not report a significant increase in acceptability after a demonstration or after treatment. (LLM, conf=0.80)
Experimental — accuracy not yet measuredEight papers regarding six different trials measured rural location as a predictor of outcomes, adherence, or acceptability.
“Eight papers regarding six different trials measured rural location as a predictor of outcomes, adherence, or acceptability [38-45].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
Across the RCTs included in this review, the risk of bias was rated as low for two studies, and moderate for two studies.
“Across the RCTs included in this review, the risk of bias was rated as low for two studies [38,40], and moderate for two studies [41,47].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
Three papers, regarding two trials, reported clinical efficacy data disaggregated by location.
“Three papers, regarding two trials, reported clinical efficacy data disaggregated by location [40,41,44].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
In one study, rural participants were more likely to report that CCBT had helped them with their depression and substance use-92% versus 75% of urban participants.
“In one study, rural participants were more likely to report that CCBT had helped them with their depression and substance use—92% versus 75% of urban participants [41].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
Kay-Lambkin et al showed that treatment preference fulfilment-computerized versus therapist delivered-had a greater impact on adherence for rural versus urban participants.
“Kay-Lambkin et al showed that treatment preference fulfilment—computerized versus therapist delivered—had a greater impact on adherence for rural versus urban participants [41].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [41]
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- Authors
- Kay-Lambkin, F. J., Baker, A. L., Kelly, B. J., & Lewin, T. J.
- Affiliations
- University of Newcastle Australia (AU)
- Royal Australian and New Zealand College of Psychiatrists (AU)
- Venue
- Journal of Dual Diagnosis
- Publisher
- Informa UK Limited
- Published
- 2012-11
- Volume
- 8
- Issue
- 4
- Pages
- 262-276
- ISSN
- 1550-4263 (ISSN-L)
- 1550-4271
- OpenAlex
- W2108887642
- Cited by
- 31
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 7 · 2014: 2 · 2013: 2 · 2012: 1
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Dual Diagnosis (publishedVersion)
- NOVA (University of Newcastle Australia) (acceptedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- Figshare (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- urban-rural differences, depression, alcohol consumption, cannabis use, comorbidities, cognitive behavioral therapy, motivational interviewing, treatment acceptability, treatment preferences, treatment retention, therapeutic relationship, remote communities, service gaps, digital mental health, social isolation
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