Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial
Open accessAbstract
Background: Computerised cognitive–behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. Aims: To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. Method: Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. Results: No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. Conclusions: Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.
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Difficulties in recruiting patients are a well-known problem in clinical trials, and long recruitment periods seem common.
“Finally, difficulties in recruiting patients is a well-known problem in clinical trials (Clarke et al., 2005; De Graaf et al., 2009; Mead et al., 2005) and long recruitment periods seem to be a common problem.”
From Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial (2014) · cites this paper as De Graaf et al., 2009
The Methodological considerations section (page unavailable) reports that only 0.14% of the original recruitment population entered the trial and describes its low response rate, supporting recruitment difficulty in this study. It does not say that recruitment difficulties are a well-known problem across clinical trials or that long recruitment periods are common. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe number of modules completed was found to correlate with outcomes in interventions that targeted cigarette smoking, depression, and anxiety disorders.
“The number of modules completed was found to correlate with outcomes in interventions that targeted cigarette smoking [42,46,47], depression [45,48-51], and anxiety disorders [52-57].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [49]
Several studies categorized participants into adherent or not, or usage categories such as low, medium, and high, while others used continuous variables or a combination of these.
“Several studies categorized participants into adherent or not [49,54,57,75], or usage categories such as low, medium, and high [60], while others used continuous variables [23,24,33-36,38-41,43-45,50-52,55,56,58,59,61,76] or a combination of these [42,46,53,64-66,77].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [49]
There are important differences between the therapist-supported intervention in the study by Kessler et al. [28] and the nonguided intervention in the study by de Graaf et al. [19].
“However, despite similar delivery context and study design, there are important differences between the therapist-supported intervention in the study by Kessler et al. [28] and the nonguided intervention in the study by de Graaf et al. [19].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [19]
In another study, adding ICBT to CAU did not improve the outcome.
“In another study, adding ICBT to CAU did not improve the outcome [19].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [19]
Previous studies of online intervention for depression in the community using a CBT protocol similar to the current study reported post-treatment effect sizes averaging 1.29 and follow-up effects averaging 1.42, based on samples ranging from 45 to 300.
“An analysis of a number of previous studies of an online intervention for depression in the community and that have used a CBT protocol similar to the intervention in the current study have reported post-treatment effect sizes averaging 1.29, and follow-up effects averaging 1.42, based on samples ranging from 45 – 300 [39,42-48].”
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- Authors
- de Graaf, L. E., Gerhards, S. A. H., Arntz, A., Riper, H., Metsemakers, J. F. M., Evers, S. M. A. A., Severens, J. L., Widdershoven, G., & Huibers, M. J. H.
- Affiliations
- Maastricht University (NL)
- Trimbos Institute (NL)
- Maastricht University Medical Centre (NL)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2009-07
- Volume
- 195
- Issue
- 1
- Pages
- 73-80
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2144014514
- Cited by
- 190
- References
- 62
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 6 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 12 · 2018: 13 · 2017: 18 · 2016: 8 · 2015: 7 · 2014: 11 · 2013: 21 · 2012: 15
- FWCI
- 22.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Funders
- ZonMw (945-04-417)
- Care and Public Health Research Institute, Universiteit Maastricht
- 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
- computerized cognitive behavioral therapy, online therapy, depression, primary care, untreated depression, multimedia intervention, depressive symptoms, general practitioner care, usual care
- MeSH terms
- Adolescent, Adult, Aged, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Primary Health Care, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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