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Cited by 133Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Meta-review of the effectiveness of computerised CBT in treating depression

Open access
Foroushani, Pooria Sarrami, Schneider, Justine, Assareh, Neda·2011·BMC Psychiatry
DOI 10.1186/1471-244x-11-131PMC PMC3180363
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Abstract

BACKGROUND: Several computerised cognitive behaviour therapy (cCBT) packages are now available to treat mild to moderate depression with or without anxiety. These have been usually been reviewed alongside cCBT for a wide range of psychological problems. Here, we single out the results of these reviews for the most common mental disorder, mild to moderate depression. The aim of this paper is to evaluate the quality of existing reviews and to enable reliable comparisons of alternative computer packages for the same patient group. METHODS: A thorough search and analysis of reviews of efficacy of cCBT published between 1999 and February 2011. RESULTS: The search yielded twelve systematic reviews from ten studies covering depression. Their methodology is appraised and selected findings are presented here. CONCLUSIONS: The meta-review supports the efficacy of cCBT for treatment of depression; however there is limited information on different approaches, whose relative cost-effectiveness remains to be demonstrated. Suggestions are made for future studies in the field.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-review appraises systematic reviews of computerised CBT (cCBT) for mild to moderate depression and finds broadly supportive evidence for efficacy, especially for MoodGYM, Beating the Blues, and Colour Your Life. However, it concludes there is limited information to compare alternative cCBT packages, and their relative cost-effectiveness remains to be demonstrated.

Key findings

  • The search identified 7031 studies; after screening, 12 papers covering 10 reviews of cCBT for depression with or without anxiety in adults were included.
  • Reviews broadly agreed that cCBT is no less effective than therapist-led CBT, reduces therapist time, is more effective than treatment as usual, and is equally or less effective than bibliotherapy.
  • MoodGYM, Beating the Blues, and Colour Your Life were reported to improve depressive symptoms; ODIN had moderate or no significant effect, and evidence for Overcoming Depression was judged insufficient.
  • The only published cost-effectiveness estimate cited was for Beating the Blues at £1250 per quality-adjusted life-year; included reviews varied in databases searched from 1 to 17 (median 5), with an average of two years between searches and publication.

Methods

  • Design: meta-review of systematic reviews examining efficacy of cCBT for depression with or without anxiety in adults, limited to English-language publications from 1999 to February 2011.
  • Data sources: Medline, Embase, CINAHL (EBSCO), British Nursing Index, Cochrane Library, and PsycINFO, plus papers suggested via personal communications; PRISMA guided the approach and CASP was used for data extraction.
  • Analysis: narrative synthesis and critical appraisal of included reviews, with findings summarised by cCBT package where the reviews named them; no new primary meta-analysis was conducted.

Limitations

  • Stated: there is limited information to compare alternative cCBT packages, relative cost-effectiveness remains to be demonstrated, included reviews provided minimal information about individual packages, and their conclusions were based on only a small number of RCTs per package.
  • Stated: reviews varied in rigour and scope, with an average of two years between searches and publication dates; 22 reviews were excluded for not describing their methodology, and some authors had declared interests or took largely uncritical approaches.
  • Evident from the text: this is a review of reviews rather than primary trial evidence, it is restricted to English-language publications and searches ending February 2011, and the included reviews covered heterogeneous interventions, populations, and outcome measures.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-244x-11-131

Cites

60 of 61 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 56 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    According to Kaltenthaler et al [9], there is only one published paper on cost effectiveness of cCBT.

    “This estimate comes from what, according to Kaltenthaler et al [9], is the only published paper on cost effectiveness of cCBT.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverly C, Parry G, Rooney G, Sutcliffe P: Computerized cognitive behavior theraphy for depression and anxiety update: A systematic review and economic evaluation. Health Technology Assessment. 2006, 10: 1-70. source

      Not checked in the free run.

  • Findingcitation

    There is not enough data with good quality to support Overcoming Depression.

    “there is not enough data with good quality to support Overcoming Depression [8-11]”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [8] Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J: A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment. 2002, 6: 1-100. 10.1007/978-94-010-0481-7_1. source

      Not checked in the free run.

    • cites [9] Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverly C, Parry G, Rooney G, Sutcliffe P: Computerized cognitive behavior theraphy for depression and anxiety update: A systematic review and economic evaluation. Health Technology Assessment. 2006, 10: 1-70. source

      Not checked in the free run.

    • cites [10] Kaltenthaler E, Parry G, Beverley C: Computerized cognitive behaviour therapy: A systematic review. Behavioural and Cognitive Psychotherapy. 2004, 32: 31-55. 10.1017/S135246580400102X. source

      Not checked in the free run.

    • cites [11] Kaltenthaler E, Parry G, Beverley C, Ferriter M: Computerised cognitive-behavioural therapy for depression: Systematic review. British Journal of Psychiatry. 2008, 193: 181-184. 10.1192/bjp.bp.106.025981. source

      Not checked in the free run.

  • Findingown data

    The included reviews varied in their rigour and scope.

    “As discussed above, the reviews varied in their rigour and scope (Additional file 3).”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Beating the Blues is judged to be effective.

    “Beating the Blues is judged to be effective [8-11]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [8] Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J: A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment. 2002, 6: 1-100. 10.1007/978-94-010-0481-7_1. source

      Not checked in the free run.

    • cites [9] Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverly C, Parry G, Rooney G, Sutcliffe P: Computerized cognitive behavior theraphy for depression and anxiety update: A systematic review and economic evaluation. Health Technology Assessment. 2006, 10: 1-70. source

      Not checked in the free run.

    • cites [10] Kaltenthaler E, Parry G, Beverley C: Computerized cognitive behaviour therapy: A systematic review. Behavioural and Cognitive Psychotherapy. 2004, 32: 31-55. 10.1017/S135246580400102X. source

      Not checked in the free run.

    • cites [11] Kaltenthaler E, Parry G, Beverley C, Ferriter M: Computerised cognitive-behavioural therapy for depression: Systematic review. British Journal of Psychiatry. 2008, 193: 181-184. 10.1192/bjp.bp.106.025981. source

      Not checked in the free run.

  • Findingnone given

    There is limited information available to compare alternative cCBT packages.

    “however there is limited information on different approaches”
    • Also stated in: § Discussion · plain
      “Yet there is limited information available to compare alternative packages”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 8

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The number of electronic databases included in the reviews varied from 1 to 17, with a median of 5.

    “The number of electronic data-bases included varied from 1 to 17 (median: 5).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One review's diagnosis of interest was depression only.

    “The diagnosis of interest of one review was depression only [16]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Garcia-Lizana F, Munoz-Mayorga I: Telemedicine for depression: a systematic review. Perspectives in Psychiatric Care. 2010, 46: 119-126. 10.1111/j.1744-6163.2010.00247.x. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Other reviews included conditions such as anxiety disorders or broader categories such as 'mental health problems', so their results include obsessive compulsive disorder, insomnia and eating disorders.

    “but others included conditions such as anxiety disorders or broader categories, such as 'mental health problems'; thus results include for example obsessive compulsive disorder, insomnia and eating disorders [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Griffiths KM, Christensen H: Review of randomised controlled trials of Internet interventions for mental disorders and related conditions. Clinical Psychologist. 2006, 10: 16-29. 10.1080/13284200500378696. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Some reviews had a broader definition of the intervention than cCBT, for example looking at 'self-help approaches'.

    “Some had a broader definition of the intervention than cCBT; for example they looked at 'self-help approaches' [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Griffiths KM, Christensen H: Review of randomised controlled trials of Internet interventions for mental disorders and related conditions. Clinical Psychologist. 2006, 10: 16-29. 10.1080/13284200500378696. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The most commonly searched databases in the reviews were Medline, PsycINFO and the Cochrane Library.

    “The most commonly-searched databases were Medline, PsycINFO and the Cochrane Library.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Thirty-one other papers were excluded for reasons such as having a focus other than efficacy of cCBT on depression.

    “Thirty-one other papers were excluded for reasons such as having a focus other than efficacy of cCBT on depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Kaltenthaler et al. undertook two reviews for the National Institute of Health Research Health Technology Assessment Board; these comprised a wide range of computerised interventions based on CBT, and were also the basis for two other publications.

    “Kaltenthaler et al. [8,9] undertook two reviews for the National Institute of Health Research Health Technology Assessment Board; these comprised a wide range of computerised interventions based on CBT, and were also the basis for two other publications [10,11].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [8] Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J: A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment. 2002, 6: 1-100. 10.1007/978-94-010-0481-7_1. source

      Not checked in the free run.

    • cites [9] Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverly C, Parry G, Rooney G, Sutcliffe P: Computerized cognitive behavior theraphy for depression and anxiety update: A systematic review and economic evaluation. Health Technology Assessment. 2006, 10: 1-70. source

      Not checked in the free run.

    • cites [10] Kaltenthaler E, Parry G, Beverley C: Computerized cognitive behaviour therapy: A systematic review. Behavioural and Cognitive Psychotherapy. 2004, 32: 31-55. 10.1017/S135246580400102X. source

      Not checked in the free run.

    • cites [11] Kaltenthaler E, Parry G, Beverley C, Ferriter M: Computerised cognitive-behavioural therapy for depression: Systematic review. British Journal of Psychiatry. 2008, 193: 181-184. 10.1192/bjp.bp.106.025981. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Kaltenthaler et al.'s reviews met all the criteria for inclusion in this meta-review, more than any of the other papers examined.

    “They met all the criteria for inclusion in this meta-review, more than any of the other papers examined.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Griffiths and Christensen looked at all Internet interventions for mental disorders.

    “Griffiths and Christensen [14] looked at all Internet interventions for mental disorders.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Griffiths KM, Christensen H: Review of randomised controlled trials of Internet interventions for mental disorders and related conditions. Clinical Psychologist. 2006, 10: 16-29. 10.1080/13284200500378696. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingown data

    By singling out the evidence pertaining to depression, the meta-review revealed reasonably consistent inferences drawn from ten systematic reviews (twelve papers) of varying quality and relevance.

    “By singling out the evidence pertaining to depression we have revealed reasonably consistent inferences drawn by from ten systematic reviews (twelve papers) of varying quality and relevance.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Even the included reviews provided minimal information about individual packages.

    “Even the included reviews provided minimal information about individual packages”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Spek et al performed a meta-analysis to explore the effectiveness of internet-based CBTs.

    “Spek et al [12] performed a meta-analysis to explore the effectiveness of internet-based CBTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Spek V, Cuijpers P, NykIicek I, Riper H, Keyzer J, Pop V: Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine. 2007, 37: 319-328. 10.1017/S0033291706008944. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    cCBT is equally or less effective than bibliotherapy.

    “equally or less effective than bibliotherapy [8,10]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J: A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment. 2002, 6: 1-100. 10.1007/978-94-010-0481-7_1. source

      Not checked in the free run.

    • cites [10] Kaltenthaler E, Parry G, Beverley C: Computerized cognitive behaviour therapy: A systematic review. Behavioural and Cognitive Psychotherapy. 2004, 32: 31-55. 10.1017/S135246580400102X. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The search was restricted to publications in English.

    “The search was restricted to publications in English, since the cCBT packages of interest use the English language.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The average two-year gap between searches and publication dates is a particular limitation in a rapidly-advancing field.

    “which is a particular limitation in a rapidly-advancing field [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Marks IM, Cuijpers P, Cavanagh K, van Straten A, Gega L, Andersson G: Meta-analysis of computer-aided psychotherapy: Problems and partial solutions. Cognitive Behaviour Therapy. 2009, 38: 83-90. 10.1080/16506070802675239. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Authors were consulted via email when necessary to verify the methodology of articles.

    “To verify the methodology of articles, authors were consulted via email when necessary.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PRISMA statement guided the approach and the Critical Appraisal Skills Programme (CASP) tool was used to extract data from the papers identified.

    “The PRISMA statement guided the approach [6] and the Critical Appraisal Skills Programme (CASP) tool [7] was used to extract data from the papers identified.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Moher D, Liberati A, Tetzlaff J, Altman DG: Reprint--Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Physical Therapy. 2009, 89: 873- source

      Not checked in the free run.

    • cites [7] The Public Health Resource Unit: 10 questions to help you make sense of reviews. OXFORD, access date: 15:08:2010, [ http://www.phru.nhs.uk/Doc_Links/S.Reviews%20Appraisal%20Tool.pdf ]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Conventional CBT is delivered face-to-face, meaning that the resources needed to treat everyone who could potentially benefit for depression are vast.

    “However, conventional CBT is delivered face-to-face, meaning that the resources which would be needed to treat everyone who could potentially benefit for depression are vast.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The effect size of each intervention as well as the costs need to be compared before superior efficacy for cCBT can be claimed.

    “but the effect size of each intervention as well as the costs need to be compared before superior efficacy for cCBT can be claimed”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    The finding that cCBT reduces therapist time could have important implications for service organisation and costs.

    “The finding that cCBT reduces therapist time could have important implications for service organisation and costs”
    Quote in the paperNot a substantial claim
20 of 20

  • The paper relies on this without support.

    Many cCBT packages compete in a market for sales and profits.

    “many cCBT packages compete in a market for sales and profits.”

  • The paper relies on this without support.

    The quality and comprehensiveness of scope of existing reviews on cCBT for depression have not been studied yet.

    “There have been different reviews on the topic, but their quality and comprehensiveness of their scope has not been studied yet.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Study-selection count is off by one

    Minor

    Subtracting 6,978 exclusions from 7,031 identified studies leaves 53 papers, not the reported 52.

    Reported 52 · recomputed 53

  • Table assigns the 2004 review the 2006 reference number

    Minor

    The table cites a 2004 Kaltenthaler paper as reference [9], but reference 9 is dated 2006.

2 of 2

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Related

Authors
Foroushani, P. S., Schneider, J., & Assareh, N.
Affiliations
University of Nottingham (GB)
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2011-08-12
Volume
11
Issue
1
Pages
131-131
ISSN
1471-244X (ISSN-L)
DOI
10.1186/1471-244x-11-131
PMC
PMC3180363
OpenAlex
W2168940134
Semantic Scholar
88a51a7585c5e7c1fe2ce1d1afdb03ece0cad8b2
Cited by
132
References
60
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 11 · 2020: 10 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 15 · 2015: 14 · 2014: 18 · 2013: 13 · 2012: 8
FWCI
16.68
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
British Occupational Health Research Foundation
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 › Clinical Psychology › Psychological Treatments and Assessments
Keywords
depression, mild to moderate depression, treatment efficacy, systematic reviews, cost-effectiveness
MeSH terms
Anxiety, Depression, Humans, Research Design, Review Literature as Topic, Therapy, Computer-Assisted, Cognitive Behavioral Therapy

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