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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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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“Another limitation is that the dropout rates are expected to be high (around 30%) [103].”
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Citations
Cites
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BackgroundInfluential
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“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
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 49
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
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 48
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 46
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
Litvin, S., Saunders, R., Jefferies, P., Seely, H., Pössel, P., & Lüttke, S. (2023) · JMIR Mental Health · doi:10.2196/47285 · Cited by 43
“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
Rikard, R. V., Berkowsky, R. W., & Cotten, S. R. (2017) · Gerontology · doi:10.1159/000482017 · Cited by 43
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
“(Kaltenthaler 2008).”
Cremers, G. E., Taylor, E. P., Hodge, L., & Quigley, A. (2019) · Clinical Gerontologist · doi:10.1080/07317115.2019.1662867 · Cited by 44
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
“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
“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 38
“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
“…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 35
“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
Srivastava, P., Mehta, M., Sagar, R., & Ambekar, A. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.101970 · Cited by 37
Sandoval, L. R., Buckey, J. C., Ainslie, R. C., Tombari, M. L., Stone, W. S., & Hegel, M. T. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.04.001 · Cited by 32
“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
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 31
“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 32
“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
Computerised cognitive behavioural therapy and its uses
Kaltenthaler, E., & Cavanagh, K. (2010) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.163 · Cited by 29
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
Simblett, S. K., Yates, M., Wagner, A. P., Watson, P., Gracey, F., Ring, H., & Bateman, A. (2017) · JMIR Mental Health · doi:10.2196/mental.6022 · Cited by 26
“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 30
Montero-Marín, J., Carrasco, J. M., Roca, M., Serrano-Blanco, A., Gili, M., Mayoral, F., Luciano, J. V., Lopez-del-Hoyo, Y., Olivan, B., Collazo, F., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-64 · Cited by 26
“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
Peñate, W. (2012) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 25
Adherence and Attrition in a Web-Based Lifestyle Intervention for People with Metabolic Syndrome.
Jahangiry, L., Shojaeizadeh, D., Montazeri, A., Najafi, M., Mohammad, K., & Yaseri, M. (2014) · Europe PMC (PubMed Central) · Cited by 24
Adams, S. H., Penton‐Voak, I. S., Harmer, C. J., Holmes, E. A., & Munafo, M. R. (2013) · Trials · doi:10.1186/1745-6215-14-161 · Cited by 28
Krishna, M., Honagodu, A., Rajendra, R., Sundarachar, R., Lane, S., & Lepping, P. (2012) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3905 · Cited by 24
Meiksin, R., Meléndez‐Torres, G. J., Falconer, J., Witzel, T. C., Weatherburn, P., & Bonell, C. P. (2021) · Systematic Reviews · doi:10.1186/s13643-020-01523-2 · Cited by 23
Integration of peer support and computer-based CBT for veterans with depression
Nelson, C. B., Abraham, K. M., Walters, H., Pfeiffer, P. N., & Valenstein, M. M. (2013) · Computers in Human Behavior · doi:10.1016/j.chb.2013.10.012 · Cited by 26
Sekizaki, R., Nemoto, T., Tsujino, N., Takano, C., Yoshida, C., Yamaguchi, T., Katagiri, N., Ono, Y., & Mizuno, M. (2017) · Early Intervention in Psychiatry · doi:10.1111/eip.12454 · Cited by 24
del Hoyo, Y. L., Oliván‐Blázquez, B., Luciano, J. V., Mayoral, F., Roca, M., Gili, M., Andres, E. M., Serrano‐Blanco, A., Collazo, F., Araya, R., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-21 · Cited by 22
Yu, J. S., Szigethy, E., Wallace, M., Solano, F., & Oser, M. (2018) · Telemedicine and e-Health · doi:10.1089/tmj.2017.0280 · Cited by 15
“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.”
Metadata
- 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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