Computerised cognitive-behavioural therapy for depression: systematic review
Open accessAbstract
Background: Computerised cognitive–behavioural therapy (CCBT) is used for treating depression and provides a potentially useful alternative to therapist cognitive–behavioural therapy (CBT). Aims: To systematically review the evidence for the effectiveness of CCBT for the treatment of mild to moderate depression. Method: Electronic databases were searched to identify randomised controlled trials. Selected studies were quality assessed and data extracted by two reviewers. Results: Four studies of three computer software packages met the inclusion criteria. Comparators were treatment as usual, using a depression education website and an attention placebo. Conclusions: There is some evidence to support the effectiveness of CCBT for the treatment of depression. However, all studies were associated with considerable drop-out rates and little evidence was presented regarding participants' preferences and the acceptability of the therapy. More research is needed to determine the place of CCBT in the potential range of treatment options offered to individuals with depression.
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The use of the Internet is a feasible solution for the accessibility problem in psychotherapy.
“The use of the Internet has been shown to be a feasible solution for the accessibility problem (18, 19).”
From Exploring the relationship between the acceptability of an internet-based intervention for depression in primary care and clinical outcomes: Secondary analysis of a randomized controlled trial (2019) · cites this paper as [19]
The introduction identifies limited access to CBT, and ‘Areas for further research’ says computerised CBT could potentially reach far more people where access is limited. The review includes an Internet-delivered programme (‘Overcoming Depression on the Internet’), but it does not establish that Internet delivery has solved the accessibility problem; its conclusion remains qualified and concerns computerised CBT more broadly. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTreatments' completion and effectiveness will improve with the acceptability of the intervention.
“Based on these results, it is important to take into account the benefit of developing interventions not only with effective treatment components but also with aspects that improve patients’ expectations and satisfaction with the intervention, because the treatments’ completion and effectiveness will improve with the acceptability of the intervention (19, 69, 83).”
From Exploring the relationship between the acceptability of an internet-based intervention for depression in primary care and clinical outcomes: Secondary analysis of a randomized controlled trial (2019) · cites this paper as [19]
The Participant satisfaction section reports that one study inferred MoodGYM’s acceptability from low drop-out rates, providing a limited connection between acceptability and completion. The Conclusions say evidence on acceptability was sparse, and the paper does not establish that increasing acceptability improves treatment completion or effectiveness. (LLM, conf=0.82)
Experimental — accuracy not yet measuredComputerised or digital CBT programmes have been shown to be effective in treating anxiety and depression in primary care settings in some studies but not all.
“Computerised or digital CBT programmes have been shown to be effective in treating anxiety and depression in primary care settings in some21–24 but not all studies.25 26”
From A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive-behavioural programme with integrated coaching for anxious adults in primary care (2018) · cites this paper as [24]
The Psychological outcomes section (page not available) reports that computerised CBT improved depression outcomes in some trials but not in one ODIN trial. The Method section limits the review to adults with mild to moderate depression, with or without anxiety; it does not establish effectiveness for anxiety as a separate condition. Nor does it establish that all the trials reporting mixed results took place in primary care. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInternet-based and computer-aided treatments are effective in treating a wide range of psychological problems, with effect sizes comparable to traditional psychological treatments.
“Internet-based and computer-aided treatments have been shown to be effective in treating a wide range of psychological problems, and have effect sizes (ES) comparable to those found for more traditional types of psychological treatments [21-32].”
From Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: Randomized controlled pilot trial (2013) · cites this paper as [29]
The Conclusions report some evidence that computerised CBT is effective for depression, and the Psychological outcomes section describes improvements in several trials. The review is limited to depression, not a wide range of psychological problems; its Results list usual care, a depression education website and an attention placebo as comparators, and it does not establish effect sizes comparable to traditional psychological treatments. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAmong the wider CCBT evidence base, low uptake has been identified as a key barrier to implementation, with an average of 12% of participants offered CCBT commencing treatment.
“Among the wider CCBT evidence base, low uptake has been identified as a key barrier to implementation, with an average of 12% of participants offered CCBT commencing treatment [26,51,52].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [51]
The Drop-out rates section raises recruitment and willingness to try CCBT as possible implementation concerns. It does not report that an average of 12% of people offered CCBT commenced treatment; its reported percentages concern drop-out after enrolment, not uptake. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Dropout rates are expected to be high (around 30%).
“Another limitation is that the dropout rates are expected to be high (around 30%) [103].”
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]”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [11]
Reviews have concluded that MoodGYM was effective in reducing symptoms of depression.
“reviews have concluded that MoodGYM was effective in reducing symptoms of depression [9,11,13,14,18,19]”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [11]
Beating the Blues is judged to be effective.
“Beating the Blues is judged to be effective [8-11]”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [11]
Reviews have concluded that ODIN had moderate or no significant effect.
“ODIN had moderate or no significant effect [9,11,14,18]”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [11]
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].”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [11]
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MethodOrmrod, J. A., Kennedy, L., Scott, J., & Cavanagh, K. (2010) · Cognitive Behaviour Therapy · doi:10.1080/16506071003675614 · Cited by 55 · see citing works
Stallard, P., Velleman, S., & Richardson, T. (2010) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2009.00540.x · Cited by 58 · see citing works
A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults
Machado, D. D. B., Laskoski, P. B., Severo, C. T., Bassols, A. M. S., Sfoggia, A., Kowacs, C., Krieger, D. V., Torres, M. B., Gastaud, M. B., Wellausen, R. S., et al. (2016) · British Journal of Psychotherapy · doi:10.1111/bjp.12204 · Cited by 59 · see citing works
Leitan, N. D., Michalak, E. E., Berk, L., Berk, M., & Murray, G. (2015) · Bipolar Disorders · doi:10.1111/bdi.12258 · Cited by 49 · see citing works
Improving the Transportability of CBT for Internalizing Disorders in Children
Meredith Elkins, R., Kathryn McHugh, R., Santucci, L. C., & Barlow, D. H. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-011-0085-4 · Cited by 52 · see citing works
“The majority of research investigating cCBT for anxiety and depression has been conducted with adults and both large trials (e.g., Proudfoot et al. 2004), and meta-analytic reviews (e.g. Kaltenthaler et al. 2008; Spek et al. 2007) have provided support for the efficacy of cCBT for these disorders.”
BackgroundPinto, M. D., Greenblatt, A. M., Hickman, R. L., Rice, H. M., Thomas, T. L., & Clochesy, J. M. (2016) · Perspectives in Psychiatric Care · doi:10.1111/ppc.12112 · Cited by 46 · see citing works
Brendryen, H., Johansen, A., Nesvåg, S., Kok, G., & Duckert, F. (2013) · JMIR Research Protocols · doi:10.2196/resprot.2371 · Cited by 48 · see citing works
“Generally, we can say that eHealth interventions [14-19], such as alcohol interventions [20-22], show promise in terms of feasibility and efficacy, but we know little about what distinguishes the effective from the less effective interventions [12,22-24].”
Feasibility study of a psychodynamic online group intervention for depression.
Lemma, A., & Fonagy, P. (2013) · Psychoanalytic Psychology · doi:10.1037/a0033239 · Cited by 49 · see citing works
Alkhaldi, G., Hamilton, F. L., Lau, R., Webster, R., Michie, S., & Murray, E. (2015) · JMIR Research Protocols · doi:10.2196/resprot.3990 · Cited by 46 · see citing works
“Numerous systematic reviews have confirmed the potential effectiveness of DIs in improving health behaviors and health outcomes [1-5,7-14].”
BackgroundWoodford, J., Farrand, P. A., Bessant, M., & Williams, C. M. (2011) · Contemporary Clinical Trials · doi:10.1016/j.cct.2011.04.013 · Cited by 48 · see citing works
Meiksin, R., Meléndez‐Torres, G. J., Falconer, J., Witzel, T. C., Weatherburn, P., & Bonell, C. P. (2021) · Journal of Medical Internet Research · doi:10.2196/22477 · Cited by 47 · see citing works
Huffman, J. C., Adams, C. N., & Celano, C. M. (2017) · Psychosomatics · doi:10.1016/j.psym.2017.09.003 · Cited by 48 · see citing works
“efficacy trials (75, 76) but in a recent large pragmatic trial of cCBT for depression (77), patients”
Kempf, M.-C., Huang, C.-H. S., Savage, R., & Safren, S. A. (2015) · Current HIV/AIDS Reports · doi:10.1007/s11904-015-0292-6 · Cited by 46 · see citing works
de Graaf, L. E., Gerhards, S. A. H., Arntz, A. R., Riper, H. M., Metsemakers, J. F. M., Evers, S., Severens, J. L., Widdershoven, G. A. M., & Huibers, M. J. H. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.07.003 · Cited by 46 · see citing works
Supported Self-Management: A Simple, Effective Way to Improve Depression Care
Bilsker, D., Goldner, E. M., & Anderson, E. (2012) · The Canadian Journal of Psychiatry · doi:10.1177/070674371205700402 · Cited by 45 · see citing works
Internet‐Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?
Mogoaşe, C., Cobeanu, O., David, D., Giosan, C., & Szentágotai, A. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22326 · Cited by 45 · see citing works
Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research
Winters, K. C., Botzet, A. M., Fahnhorst, T., Stinchfield, R. D., & Koskey, R. (2008) · Springer eBooks · doi:10.1007/978-0-387-09732-9_4 · Cited by 45 · see citing works
Strøm, J., Nielsen, C. V., Jørgensen, L. B., Andersen, N. T., & Laursen, M. (2018) · The Spine Journal · doi:10.1016/j.spinee.2018.11.011 · Cited by 46 · see citing works
Litvin, S., Saunders, R., Jefferies, P., Seely, H., Pössel, P., & Lüttke, S. (2023) · JMIR Mental Health · doi:10.2196/47285 · Cited by 43 · see citing works
“It was chosen specifically to explore the secondary hypothesis of attrition, as the app has already been tested in another RCT [59] and is associated with a reduction in depression [60] and anxiety [61].”
MethodBotella, C., Mira, A., Moragrega, I., García-Palacios, A., Bretón-López, J., Castilla, D., Riera López del Amo, A., Soler, C., Molinari, G., Quero, S., et al. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s93315 · Cited by 42 · see citing works
Rikard, R. V., Berkowsky, R. W., & Cotten, S. R. (2017) · Gerontology · doi:10.1159/000482017 · Cited by 43 · see citing works
Tomorrow's world: current developments in the therapeutic use of technology for psychosis
O'Hanlon, P., Aref-Adib, G., Fonseca, A., Lloyd‐Evans, B., Osborn, D., & Johnson, S. (2016) · BJPsych Advances · doi:10.1192/apt.bp.115.014654 · Cited by 41 · see citing works
“(Kaltenthaler 2008).”
Cremers, G., Taylor, E., Hodge, L., & Quigley, A. (2019) · Clinical Gerontologist · doi:10.1080/07317115.2019.1662867 · Cited by 36 · see citing works
Martin, S., Sutcliffe, P., Griffiths, F., Sturt, J., Powell, J., Adams, A., & Dale, J. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2010.11.014 · Cited by 36 · see citing works
“Studies evaluating Computerised Cognitive Behavioural Therapy (CCBT) use were excluded from this review [10].”
MethodMira, A., Soler, C., Alda, M., Baños, R., Castilla, D., Castro, A., García-Campayo, J., García-Palacios, A., Gili, M., Hurtado, M., et al. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00325 · Cited by 29 · see citing works
“Based on these results, it is important to take into account the benefit of developing interventions not only with effective treatment components but also with aspects that improve patients’ expectations and satisfaction with the intervention, because the treatments’ completion and effectiveness will improve with the…”
BackgroundMontero‐Marín, J., Prado-Abril, J., Botella, C., Mayoral, F., Baños, R., Herrera‐Mercadal, P., Romero‐Sanchiz, P., Gili, M., Castro, A., Nogueira‐Arjona, R., et al. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3985 · Cited by 33 · see citing works
“Several studies show that Web-based psychological treatments are effective for the treatment of depression, in both unguided and guided interventions, although the effects are more favorable in the latter case [33,36-38].”
Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review
Treanor, C., Kouvonen, A. M., Lallukka, T. M., & Donnelly, M. (2021) · JMIR Mental Health · doi:10.2196/23091 · Cited by 35 · see citing works
“…not complete components, number of studies): 25% agreed to take partPatient recruitment; number of patients who accessed website and agreed to take Kaltenthaler et al (2008) [34]b Beating the Blues (26%-part in study; drop-outs; 45%, 5 studies); MoodGymnumber of patients who dropped out of the…”
BackgroundTodd, N. J., Solis‐Trapala, I., Jones, S. H., & Lobban, F. A. (2012) · Contemporary Clinical Trials · doi:10.1016/j.cct.2012.02.011 · Cited by 34 · see citing works
“The internet is one of the top three sources of information accessed by people withmental health problems [55] and is an acceptable and effective way of delivering therapy [28,38].”
BackgroundMcMurchie, W., Macleod, F. J., Power, K., Laidlaw, K., & Prentice, N. P. (2013) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3935 · Cited by 33 · see citing works
Srivastava, P., Mehta, M., Sagar, R., & Ambekar, A. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.101970 · Cited by 32 · see citing works
Sandoval, L., Buckey, J., Ainslie, R., Tombari, M., Stone, W., & Hegel, M. T. (2016) · The Behavior Therapist · doi:10.1016/j.beth.2016.04.001 · Cited by 29 · see citing works
“For instance, in a systematic review of CBs for depression, Kaltenthaler et al. (Kaltenthaler, Parry, Beverley, & Ferriter, 2008) reported dropout rates ranging from 0% to 75%.”
BackgroundSigning Off: Predicting Discontinued ICT Usage Among Older Adults in Assisted and Independent Living
Berkowsky, R. W., Rikard, R. V., & Cotten, S. R. (2015) · Lecture notes in computer science · doi:10.1007/978-3-319-20913-5_36 · Cited by 31 · see citing works
A computer-assisted depression intervention in primary care
Levin, W., Campbell, D. R., McGovern, K., Gau, J. M., Kosty, D. B., Seeley, J. R., & Lewinsohn, P. M. (2010) · Psychological Medicine · doi:10.1017/s0033291710001935 · Cited by 30 · see citing works
“In recent years, a number of randomized controlled trials have demonstrated the benefits of computerdelivered interventions in comparison with usual treatment and, in some cases, in comparison with therapist-delivered interventions (Proudfoot et al. 2003 ; Grime, 2004 ; Kaltenthaler et al. 2006 ; Seligman, 2006 ; Kalt…”
ResultThe Emerging Role of Technology in Cognitive–Behavioral Therapy for Anxious Youth: A Review
Berry, R. R., & Lai, B. S. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0184-5 · Cited by 30 · see citing works
“The efficacy of computer-and internet-based CBT for adults with anxiety disorders adults is supported by large trials (Proudfoot et al. 2004) and meta-analytic reviews (e.g. Kaltenthaler et al. 2008; Spek et al. 2007).”
MethodMuriungi, S. K., & Ndetei, D. M. (2013) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v19i2.401 · Cited by 37 · see citing works
Computerised cognitive behavioural therapy and its uses
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Self-citationPsychosocial Implications of Avatar Use in Supporting Therapy for Depression
Claudia, P., Burton, C. D., McKinstry, B., Szentatotai, A., Daniel, D., Serrano‐Blanco, A., Ferrini, L., Albertini, S., Carlos, C. J., Estevez, S., et al. (2012) · Studies in health technology and informatics · doi:10.3233/978-1-61499-121-2-329 · Cited by 28 · see citing works
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“There is good evidence to support the effectiveness of cCBT for depression [10,35].”
The therapist–client relationship, computerized self‐help and active therapy ingredients
Peck, D. F. (2009) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.669 · Cited by 26 · see citing works
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“The therapeutic solutions that are most frequently investigated are brief psychotherapies that can be administrated from a personal computer, such as conflict resolution therapy [6], bibliotherapy [7], self-help programs [8] and computer-assisted psychotherapy programs [9].”
BackgroundAbout the effectiveness of telehealth procedures in psychological treatments
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Adherence and Attrition in a Web-Based Lifestyle Intervention for People with Metabolic Syndrome.
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Integration of peer support and computer-based CBT for veterans with depression
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“18, 19 In addition, digital CBT programs have demonstrated effectiveness in reducing anxiety and depression in PC. 20–23 Lantern is one such guided, digital cognitive behavioral program that combines evidence-based anxiety management skills with motivational coaching.”
- Authors
- Kaltenthaler, E., Parry, G., Beverley, C., & Ferriter, M.
- Affiliations
- University of Sheffield (GB)
- Rampton Hospital (GB)
- Corresponding author
- Kaltenthaler, Eva
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2008-09
- Volume
- 193
- Issue
- 3
- Pages
- 181-184
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2157606892
- Cited by
- 206
- References
- 18
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 6 · 2022: 13 · 2021: 12 · 2020: 9 · 2019: 11 · 2018: 11 · 2017: 15 · 2016: 12 · 2015: 19 · 2014: 14 · 2013: 24 · 2012: 20
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research
- Health Technology Assessment Programme
- 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
- computerized cognitive behavioral therapy, depression, mild to moderate depression, online therapy, treatment effectiveness, dropout rates, acceptability
- MeSH terms
- Adult, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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