Telephone-supported computerised cognitive–behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial
Open accessAbstract
Background: Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials. Aims: We tested the benefits of adding telephone support to cCBT. Method: We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months. Results: Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints. Conclusions: Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
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Existing digital therapeutic and telehealth interventions with didactic components have encountered challenges including relatively low adherence, unsustainability, and inflexibility.
“The existing digital therapeutic and telehealth interventions with didactic components, which enable health care providers to communicate with patients via digital platforms (eg, email and video call), have encountered several challenges, including relatively low adherence, unsustainability, and inflexibility [3,4].”
From Artificial Intelligence-Based Chatbots for Promoting Health Behavioral Changes: Systematic Review. (2023) · cites this paper as [4]
The Adherence and adverse events section reports low completion of computerised CBT: 10.4% with minimal support and 19.4% with telephone facilitation completed all five sessions. The paper does not establish that these interventions are unsustainable or inflexible; its Implications section instead says telephone-supported CBT could be offered at scale. Its findings also concern CBT for depression, not digital therapeutic and telehealth interventions generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the last 10 years, several large implementation studies of DMHIs have shown that the majority of patients offered these interventions do not engage at the recommended frequency or complete the full course of treatment.
“In the last 10 years, several large implementation studies of DMHIs have shown that the majority of patients offered these interventions do not engage at the recommended frequency or complete the full course of treatment [4-6].”
From Digital Mental Health Interventions for Depression: Scoping Review of User Engagement (2022) · cites this paper as [4]
Concerns related to sustained engagement with web-based psychiatric interventions have been reported in routine-care implementation studies.
“Similarly, concerns related to sustained engagement with web-based psychiatric interventions have been reported in routine-care implementation studies [4-6,17].”
From Digital Mental Health Interventions for Depression: Scoping Review of User Engagement (2022) · cites this paper as [4]
Other trials have had high dropout rates.
“Although some trials have shown strong patient engagement in health care settings (59), others have had high dropout rates (60, 61).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [60]
Patient engagement has been a challenge for some digital mental health treatments.
“Patient engagement has been a challenge for some DMHTs. Although some trials have shown strong patient engagement in health care settings (59), others have had high dropout rates (60, 61).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [60]
Existing digital therapies have suffered from low adherence and concerns about their efficiency without continued human support.
“Existing digital therapies have suffered from low adherence and concerns about their efficiency without continued human support [12,13].”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [13]
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Depression intervention using AI chatbots with social cues: a randomized trial of effectiveness
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Coventry, P. A., Bower, P., Blakemore, A., Baker, E., Hann, M., Li, J., Paisley, A. N., & Gibson, M. (2019) · npj Digital Medicine · doi:10.1038/s41746-019-0080-6 · Cited by 18 · see citing works
Self-citationEditorial: Computers and Games for Mental Health and Well-Being
Khazaal, Y., Favrod, J., Sort, A., Borgeat, F., & Bouchard, S. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00141 · Cited by 18 · see citing works
“Translation of such results in naturalistic settings was, however, compromised by low engagement [17, 18], arguing for a paradigm shift in this area (Fleming et al.).”
ResultChow, P. I., Showalter, S. L., Gerber, M. S., Kennedy, E. M., Brenin, D. R., Schroen, A. T., Mohr, D. C., Lattie, E. G., & Cohn, W. F. (2018) · JMIR Research Protocols · doi:10.2196/11452 · Cited by 16 · see citing works
“…many apps are available on app stores, digital health technologies (which include apps, wearable sensors, and internet-delivered interventions) that are connected to a care manager in a health care setting are increasingly being used as a method of providing technology-enabled services [37,38].”
Mogk, J. M., Idu, A., Bobb, J. F., Key, D. L., Wong, E. S., Palazzo, L. G., Stefanik-Guizlo, K., King, D., Beatty, T. C., Dorsey, C. N., et al. (2024) · JMIR Formative Research · doi:10.2196/59088 · Cited by 14 · see citing works
Mancone, S., Diotaiuti, P., Valente, G., Corrado, S., Bellizzi, F., Vilarino, G. T., & Andrade, A. (2023) · Behavioral Sciences · doi:10.3390/bs13070550 · Cited by 14 · see citing works
“Existing digital therapy formats typically emphasize psychoeducation and a modular style, one with fixed content and duration, which is inflexible for users [40,41].”
BackgroundDeady, M., Collins, D., Gayed, A., Harvey, S. B., & Bryant, R. A. (2023) · Digital Health · doi:10.1177/20552076231155680 · Cited by 14 · see citing works
Internetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick
Backenstrass, M., & Wolf, M. (2018) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000339 · Cited by 8 · see citing works
Matson, T. E., Hermes, E. D. A., Lyon, A. R., Quanbeck, A., Schueller, S. M., Wilson, S. M., & Glass, J. E. (2025) · Annals of Epidemiology · doi:10.1016/j.annepidem.2025.02.007 · Cited by 11 · see citing works
Lee, H., Choi, E. H., Shin, J. U., Kim, T., Oh, J., Shin, B., Sim, J. Y., Shin, J., & Kim, M. (2023) · JMIR Formative Research · doi:10.2196/51225 · Cited by 9 · see citing works
Musker, M., Short, C. E., Licinio, J., Wong, M., & Bidargaddi, N. P. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.09.012 · Cited by 11 · see citing works
Guided Internet-Delivered Treatment for Depression: Scoping Review
Børtveit, L., Dechsling, A., Sütterlin, S., Nordgreen, T., & Nordahl‐Hansen, A. (2022) · JMIR Mental Health · doi:10.2196/37342 · Cited by 11 · see citing works
Report of the 2016 Mental Health Expert Panel on suicide prevention in the Canadian Armed Forces
Sareen, J., Holens, P. L., Turner, S. E., Jetly, R., Kennedy, S. H., Heisel, M. J., Cooper, K., Mota, N. P., Comtois, K. A., Stein, M. B., et al. (2018) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh.2017-0043 · Cited by 10 · see citing works
Castro, A., García‐Palacios, A., del Hoyo, Y. L., Mayoral, F., Pérez-Ara, M. Á., Baños, R. M., García‐Campayo, J., Hurtado, M. M., Botella, C., Barceló‐Soler, A., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041774 · Cited by 9 · see citing works
“However, adherence rates reported herein are higher than those reported in previous studies, in which they do not exceed 20% of participants who completed all treatment sessions [26,52,53].”
ResultUnpacking patient engagement in remote consultation
Liu, Z., Brandon‐Jones, A., & Vasilakis, C. (2024) · International Journal of Operations & Production Management · doi:10.1108/ijopm-03-2023-0188 · Cited by 8 · see citing works
Telehealth and Women’s Perinatal Mental Health
Kingston, D. E., & Rocha, R. (2020) · Springer eBooks · doi:10.1007/978-3-030-29081-8_23 · Cited by 6 · see citing works
Poulter, M. M. L., Wahl, T. D., Kiviharju, M. J., Campbell, T. S., & Gordon, J. L. (2025) · Human Reproduction · doi:10.1093/humrep/deaf237 · Cited by 5 · see citing works
Moriarty, A. S., Paton, L. W., Snell, K. I. E., Riley, R. D., Buckman, J. E. J., Gilbody, S. M., Chew-Graham, C. A., Ali, S., Pilling, S., Meader, N., et al. (2021) · Diagnostic and Prognostic Research · doi:10.1186/s41512-021-00101-x · Cited by 5 · see citing works
Self-citationPapiernik, P., Dzula, S., Zimanyi, M., Millgate, E., Bouazzaoui, M., Buttimer, J., Warren, G., Cooper, E., Catarino, A., Mehew, S., et al. (2025) · JMIR Human Factors · doi:10.2196/76377 · Cited by 4 · see citing works
The Internet and CBT: A New Clinical Application of an Effective Therapy
Gratzer, D., Khalid-Khan, F., & Balasingham, S. (2018) · InTech eBooks · doi:10.5772/intechopen.72146 · Cited by 4 · see citing works
“An economic analysis indicated that telephone support could increase quality of life (in quality-adjusted life year [QALY]) and reduce healthcare costs with a likelihood of being cost effective at ₤6933 per QALY [36, 37].”
BackgroundSogomonjan, M., Kerikmäe, T., & Ööpik, P. (2018) · TalTech Journal of European Studies · doi:10.1515/bjes-2018-0019 · Cited by 4 · see citing works
“…between treatment groups in all studies (Berger et al., 2017; Høifødt et al., 2013; Newby et al., 2013; Rollman et al., 2017; Simblett et al., 2017; Gilbody et al., 2017; de Graaf et al., 2009; Levin et al., 2011; de Graaf et al., 2011; Hickie et al., 2010; Kessler et al., 2009; Gilbody et al.,…”
BackgroundResultInfluentialAsarnow, J. R. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18050554 · Cited by 4 · see citing works
“conclusion consistent with results of other studies indicating that technology-enhanced intervention use is greater when paired with telephone coaching (5) or other approaches for enhancing motivation (7).”
ResultHe, Y., Yang, L., Zhu, X., Wu, B., Zhang, S., Qian, C., & Tian, T. (2022) · doi:10.2196/preprints.40719 · Cited by 3 · see citing works
Kölch, M. G., Romanos, M., Roth-Sackenheim, C., & Schramm, E. (2020) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000739 · Cited by 3 · see citing works
Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment
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Self-citationPERSPECTIVAS PARA O USO DA TELEMEDICINA NO ATENDIMENTO DE SAÚDE MENTAL NA ATENÇÃO PRIMÁRIA
Rodrigues, T. F. C. D. S., Cardoso, L. C. B., da Silva, M., Paiano, M., Salci, M. A., & Radovanovic, C. A. T. (2022) · Enfermagem em Foco · doi:10.21675/2357-707x.2022.v13.e-202222esp1 · Cited by 4 · see citing works
Eicher, S., Heinrich, M., Zagorscak, P., Brose, A., & Knaevelsrud, C. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100818 · Cited by 1 · see citing works
“None of the other studies of IBIs for depressive symptoms, included such an initial contact, as participants were recruited directly from primary care after receiving a diagnosis of depression (Gilbody et al., 2017; Pihlaja et al., 2020).”
InfluentialDriving User Engagement: A Mixed‐Method Marketing Approach for Digital Mental Health Intervention
Jena, R. K., Botella-Carrubí, D., & Móstoles, R. C. (2025) · Psychology and Marketing · doi:10.1002/mar.70060 · Cited by 1 · see citing works
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Fox, F. E., Hahn, J. S., Jude, B., Li, J., López-López, J. A., Stawarz, K., et al. (2025) · Programme Grants for Applied Research · doi:10.3310/gjnw3912 · Cited by 1 · see citing works
Self-citationRintell, L. S., Buchholz, K. R., & Gladstone, T. R. G. (2021) · Springer eBooks · doi:10.1007/978-3-030-83469-2_6 · Cited by 1 · see citing works
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Hahn, J. S., Jude, B., Li, J., Logan, M. X., Burrage, A., Gilbody, S. M., et al. (2026) · The Lancet Primary Care · doi:10.1016/j.lanprc.2026.100164 · Cited by 1 · see citing works
Self-citationGhosh, A., Cherian, R. J., Wagle, S., Sharma, P., Kannan, K. R., Bajpai, A., & Gupta, N. (2021) · medRxiv · doi:10.1101/2021.11.24.21266799 · Cited by 1 · see citing works
“Recent studies and meta-analyses indicate that for depressive symptoms, guided cCBT interventions are more beneficial than unguided cCBT interventions (Cuijpers et al., 2019; Gilbody et al., 2017; Johansson & Andersson, 2012; Karyotaki et al., 2021; Wright et al., 2019).”
BackgroundPostpartum depression in the UAE
Hanach, N. (2024) · doi:10.26481/dis.20240923nh · Cited by 1 · see citing works
Les applications pour smartphones (apps) : une opportunité pour la santé mentale
Khazaal, Y. (2018) · Elsevier eBooks · doi:10.1016/b978-2-294-75915-4.00027-x
Methods of Delivering Treatment
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.007
Lipschitz, J. M., Boxtel, R. V., Torous, J. B., Firth, J., Lebovitz, J. G., Burdick, K. E., & Hogan, T. P. (2022) · doi:10.2196/preprints.39204
Economic Benefits of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.013
The General Philosophical Principles of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.004
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.015
The Four Phases of Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.006
What Are the Qualities of a Good Nidotherapist?
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.010
How to Develop Skills in Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.009
Nidotherapy for People with Intellectual Disability and Dementia
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.008
Common Misconceptions about Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.014
Tyrer, P. J., & Tyrer, H. (2018) · doi:10.1017/9781911623403.001
Assessing the Patient for Nidotherapy
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.005
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.012
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.016
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.003
Nidotherapy, Physical and Occupational Health and Social Care
Tyrer, P. J., & Tyrer, H. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623403.011
Tyrer, P. J., & Tyrer, H. (2018) · doi:10.1017/9781911623403.002
- Authors
- Gilbody, S., Brabyn, S., Lovell, K., Kessler, D., Devlin, T., Smith, L., Araya, R., Barkham, M., Bower, P., Cooper, C., Knowles, S., Littlewood, E., Richards, D. A., Tallon, D., White, D., Worthy, G., & collaborative, O. B. O. T. R.
- Affiliations
- University of Manchester (GB)
- University of Exeter (GB)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-05
- Volume
- 210
- Issue
- 5
- Pages
- 362-367
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2591924907
- Cited by
- 116
- References
- 29
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 4 · 2023: 18 · 2022: 8 · 2021: 15 · 2020: 13 · 2019: 7 · 2018: 29 · 2017: 4
- FWCI
- 16.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Explore Bristol Research (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- University of Derby Online Research Archive. (University of Derby) (submittedVersion)
- Figshare (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- Funders
- London School of Hygiene and Tropical Medicine
- National Institute for Health and Care Research (NF-SI-0514-10037, NF-SI-0611-10203, 06/43/504, HTA/06/43/504)
- University of Exeter
- University of Bristol
- Health Technology Assessment Programme (06/43/504)
- NIHR School for Primary Care Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- computerized cognitive behavioral therapy, telephone support, depression, MoodGYM, treatment engagement, primary care, anxiety, somatic symptoms, low-intensity psychological interventions
- MeSH terms
- Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Telephone, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Remote Consultation, Medication Adherence
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