The effectiveness of computerized cognitive behavioural therapy in routine care
Open accessAbstract
Objectives and design The efficacy of a Computerized Cognitive Behavioural Therapy (CCBT) package, Beating the Blues , has been demonstrated in a large randomized controlled trial. The current study tests the generalizability of this finding in a naturalistic non‐randomized trial. Method 219 patients with anxiety and/or depression were recruited to receive CCBT in routine care. The Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) and Work and Social Adjustment scale (WSA) were administered pre‐treatment, immediately on completing treatment and at 6 months post‐treatment. Single‐item self‐report measures of anxiety and depression were also collected during each treatment session. Results Completer and intention‐to‐treat analysis demonstrated statistically and clinically significant improvements on the CORE‐OM, WSA and in self‐reported anxiety and depression. Intention‐to‐treat analysis indicated an average 0.29‐point drop on the CORE‐OM, equating to an uncontrolled pre‐post effect size of 0.50. Research completers achieved an average 0.61‐point drop equating to an uncontrolled pre‐post size of 1.00 on the same measure. Where data was available (18%), these benefits were maintained at week 32 (6 months follow‐up). Conclusion CCBT can be an effective first line tool within a stepped care framework for the management of common mental health problems.
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Some previous research has assessed the relevance of low-intensity internet-delivered treatments for anxiety disorders in service-based settings.
“Some previous research has assessed the relevance of low-intensity internet-delivered treatments for anxiety disorders in service-based settings [56-58].”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [57]
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BackgroundTRANSDIAGNOSTIC INTERNET TREATMENT FOR ANXIETY AND DEPRESSION
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MethodChild and youth mental health: Integrated health care using contemporary competency-based teams
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“For example, good outcomes may be found in cognitive behavioural therapy applied by psychiatrists, psychologists, nurses, social workers, counsellors or even computer-assisted therapy (5,6).”
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“In addition, effectiveness is maintained 6 months after finishing the therapy program [18].”
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“We chose BtB because (a) it is widely used and researched (Cavanagh et al., 2006; Learmonth, Trosh, Rai, Sewell, & Cavanagh, 2008; Proudfoot et al., 2003); (b) therapeutic alliance between BtB and its users has been investigated, providing a basis for comparison (Ormrod et al.)”
MethodTaking computerized CBT beyond primary care.
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“Other studies utilizing iCBT have recorded similar improvements in their samples [53-55], yet qualitative investigations may be necessary to understand the impact of iCBT on improvements in functioning further.”
Integration of peer support and computer-based CBT for veterans with depression
Nelson, C., Abraham, K. M., Walters, H. M., Pfeiffer, P. N., & Valenstein, M. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2013.10.012 · Cited by 26 · see citing works
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 · see citing works
“Recently, other CDP programs without the presence of a psychotherapist, such as "Blues Begone", have been evaluated with adequate effectiveness not only in randomized controlled trials [23] but in naturalistic studies as well [24].”
BackgroundImpact of School Staff Health on Work Productivity in Secondary Schools in Massachusetts
Alker, H., Wang, M. L., Pbert, L. A., Thorsen, N., & Lemon, S. C. (2015) · Journal of School Health · doi:10.1111/josh.12266 · Cited by 21 · see citing works
Depression in primary care: three key challenges
Lester, H., & Howe, A. (2008) · Postgraduate Medical Journal · doi:10.1136/pgmj.2008.068387 · Cited by 19 · see citing works
“Computerised CBT has become very prominent as a potential effective therapy, which can be user-led and is seen as less medicalising than pharmacological interventions.”
BackgroundLopez-Montoyo, A., Quero, S., Montero-Marin, J., Barcelo-Soler, A., Beltran, M., Campos, D., & Garcia-Campayo, J. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2298-x · Cited by 19 · see citing works
Sin, J., Woodham, L. A., Henderson, C., Williams, E., Hernández, A. S., & Gillard, S. (2019) · Digital Health · doi:10.1177/2055207619871148 · Cited by 19 · see citing works
Self-Management of Depression: A Manual for Mental Health and Primary Care Professionals
Yeung, A., Feldman, G. C., & D, M. F. M. (2009) · Medical Entomology and Zoology · Cited by 18 · see citing works
Depression and a Stepped Care Model
Broten, L. A., Naugle, A. E., Kalata, A. H., & Gaynor, S. T. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3_2 · Cited by 18 · see citing works
Dobkin, R. D., Durland, L., Interian, A., & Pretzer‐Aboff, I. (2014) · Smart Homecare Technology and TeleHealth · doi:10.2147/shtt.s45044 · Cited by 18 · see citing works
“Although the evidence-base supporting the use of telehealth technologies to treat primary depressive disorders is quite impressive, 25,29,34,35,54,88–93 the overwhelming majority of these seminal studies did not meet the inclusion criteria for the current review (eg, telehealth-to-home, focus on…”
Lobban, F., Dodd, A., Dagnan, D., Diggle, P., Griffiths, M., Hollingsworth, B., Knowles, D., Long, R., Mallinson, S., Morriss, R., et al. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.01.004 · Cited by 20 · see citing works
“In treating depression and anxiety, computerised interventions have already been shown to be clinically and cost-effective, acceptable to service users, and highly accessed [6–10].”
BackgroundRichards, D., Timulak, L., Doherty, G., Sharry, J., McLoughlin, O., Rashleigh, C., Colla, A., & Joyce, C. (2014) · Trials · doi:10.1186/1745-6215-15-145 · Cited by 16 · see citing works
“Some previous research has assessed the relevance of low-intensity internet-delivered treatments for anxiety disorders in service-based settings [56-58].”
BackgroundDysthe, K. K., Haavet, O. R., Røssberg, J. I., Brandtzæg, P. B., Følstad, A., & Klovning, A. (2021) · Journal of Medical Internet Research · doi:10.2196/28765 · Cited by 16 · see citing works
“Similar solutions also show promising results in adolescents [39,41,42].”
Processes of Change in Self‐Directed Couple Relationship Education
Wilson, K. L., & Halford, W. K. (2008) · Family Relations · doi:10.1111/j.1741-3729.2008.00529.x · Cited by 16 · see citing works
Hamid, N. (2023) · PsyCh Journal · doi:10.1002/pchj.715 · Cited by 15 · see citing works
“Other studies proposed conflicting results, for example, Cavanagh et al. (2006) suggested that 20% – 33% of patients declined ICBT programmes in comparison to 25% – 50% of patients forgoing face-to-face psychotherapy after initial assessments; this implies that ICBT programmes could be slightly…”
ResultDeveloping a web-based stress management intervention for occupational support workers
Ridge, M., WELLS, J. S. G., Denny, M., Cunningham, J., & Chalder, T. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.556162 · Cited by 15 · see citing works
“There is evidence to suggest that Cognitive Behavioural Therapy (CBT) programmes for treating stress and anxiety can be effective in a web-based format (Cavanagh et al., 2006; Kenwright et al., 2001).”
BackgroundPsychosocial Characteristics of Optimum Performance in Isolated and Confined Environments (ICE)
Palinkas, L. A., Keeton, K. E., Shea, C., & Leveton, L. B. (2010) · NASA Technical Reports Server (NASA) · Cited by 15 · see citing works
Prieto, C. D., & Sánchez, J. N. G. (2015) · Revista de Psicodidáctica · doi:10.1387/revpsicodidact.13854 · Cited by 17 · see citing works
Ratajska, A. M., Zurawski, J., Healy, B., & Glanz, B. (2019) · International Journal of MS Care · doi:10.7224/1537-2073.2017-094 · Cited by 17 · see citing works
An open trial in the NHS of Blues Begone®: a new home based computerized CBT program
Purves, D. G., Bennett, M., & Wellman, N. (2009) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465809990282 · Cited by 14 · see citing works
“95% CI 7.1 – 11.8.and a significant reduction in total CORE-OM scores at study end t (55) = 9.2. p < .001, SD = .79, ES = 1.4, CI .76 – 1.2.”
MethodResultInfluentialTitov, N., Dear, B. F., Johnston, L., & Terides, M. (2012) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.17.num.3.2012.11842 · Cited by 13 · see citing works
Elsegood, K. J., & Powell, D. J. (2008) · Counselling and Psychotherapy Research · doi:10.1080/14733140802163914 · Cited by 13 · 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
Finding Web-Based Anxiety Interventions on the World Wide Web: A Scoping Review
Ashford, M. T., Olander, E. K., & Ayers, S. (2016) · JMIR Mental Health · doi:10.2196/mental.5349 · Cited by 11 · see citing works
Nordgreen, T., & Havik, O. E. (2011) · Professional Psychology Research and Practice · doi:10.1037/a0022729 · Cited by 11 · see citing works
Lygidakis, C., Wallace, P., Tersar, C., Marcatto, F., Ferrante, D., Vedova, R. D., Scafuri, F., Scafato, E., & Struzzo, P. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5232 · Cited by 11 · see citing works
“Initially adopted primarily for the management of patients with mental health problems including depression and anxiety [20], facilitated access has been extended to addictive behaviors including smoking cessation and alcohol screening, as well health promotion and the management of long-term…”
Healthcare and the Effect of Technology
Kabene, S. (2010) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-61520-733-6 · Cited by 17 · see citing works
“Cavanagh et al. (2006), Grime (2004), • and Proudfoot et al. (2004) evaluated an interactive, multimedia, computerized cognitive behavioral therapy package.”
BackgroundTailoring a Digital Mental Health Program for Patients With Sickle Cell Disease: Qualitative Study
Nikolajski, C., O’Brien, J. A., Nardo, E., Szigethy, E., & Jonassaint, C. R. (2023) · JMIR Mental Health · doi:10.2196/44216 · Cited by 10 · see citing works
“This is a major gap in care, given that effective and cost-efficient mental health treatments, such as cognitive behavioral therapy (CBT), exist but are often not part of comprehensive SCD care [11-15].”
Salisbury, C., O’Cathain, A., Thomas, C., Edwards, L., Montgomery, A. A., Hollinghurst, S. P., Large, S., Nicholl, J. P., Pope, C. J., Rogers, A. E., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05010 · Cited by 9 · see citing works
“For example, a RCT of an internet-based CBT programme, Beating the Blues, showed that computerised care outcomes were comparable to face-to-face care outcomes, nearly half of those completing the programme were reported to be clinically recovered and a computerised CBT programme for the management of mild to moderate…”
BackgroundResultPlanert, J., Machulska, A., Hildebrand, A. S., Roesmann, K., Otto, E., & Klucken, T. (2022) · Trials · doi:10.1186/s13063-022-06366-x · Cited by 10 · see citing works
Mercer, V. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3_9 · Cited by 9 · see citing works
Rotondi, A. J., Belnap, B. H., Rothenberger, S. D., Feldman, R., Hanusa, B. H., & Rollman, B. L. (2023) · JMIR Mental Health · doi:10.2196/52197 · Cited by 8 · see citing works
Developments in Technology-Delivered Psychological Interventions
Richards, D. (2013) · Universitas Psychologica · doi:10.11144/javeriana.upsy12-2.dtdp · Cited by 8 · see citing works
Villemaire-Krajden, R., & Myhr, G. (2019) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000396 · Cited by 7 · see citing works
Herrera‐Mercadal, P., Montero‐Marín, J., Plaza, I., Medrano, C., Andres, E. M., del Hoyo, Y. L., Gili, M., & García‐Campayo, J. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.060 · Cited by 6 · see citing works
“Naturalistic studies to assess the efficacy and pattern of use of these programmes in real daily clinical conditions are compulsory but infrequent (Cavanagh et al., 2006).”
BackgroundComputerised CBT self‐help for depression in Higher Education: Reflections on a pilot
Mitchell, N. (2009) · Counselling and Psychotherapy Research · doi:10.1080/14733140902993343 · Cited by 6 · see citing works
“Cavanagh, Shapiro, Van den Berg, Swain, Barkham, & Proudfoot, 2006 ).”
Telephonic support to facilitate return to work: what works, how, and when?
McCluskey, S. (2014) · University of Huddersfield Repository (University of Huddersfield) · Cited by 7 · see citing works
Yeager, C. M. (2016) · Digital Collections of Colorado (Colorado State University) · Cited by 5 · see citing works
Development of an audio and computer cognitive behavioral therapy for depression in older adults
Morthland, M., Shah, A., Meadows, J. T., & Scogin, F. R. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1609901 · Cited by 5 · see citing works
“A systematic review, a meta-analysis, and recent studies suggest that CATs are evidence-based; potentially a first step in treating depression (Cavanagh et al., 2006; Cavanagh & Shapiro, 2004; Kaltenthaler et al. 2002; Karyotaki et al., 2017; Wright et al., 2005; Barrett & Gershkovich, 2014;…”
MethodHillier, L. (2018) · Lancaster University · doi:10.17635/lancaster/thesis/406 · Cited by 5 · see citing works
Setiyowati, A. J. (2017) · doi:10.2991/icet-17.2017.45 · Cited by 4 · see citing works
“The development of computer-based CBT, web, and phone effectively manage the problem of general mental disorders (McCrone et al. , 2004; Cavanagh et al. 2006; Ehde et al. , 2014) In order to obtain the benefit from cognitive behavioral therapy (CBT), it requires a complete commitment and…”
Palmer, D., Pittaway, S., Cook, L., Garner, S., Holttum, S., Sansom, J., & Bassi, C. (2012) · Journal of Children s Services · doi:10.1108/17466661211261361 · Cited by 4 · see citing works
Bjornstad, G. J., Sonthalia, S., Rouse, B., Freeman, L., Hessami, N., Dunne, J. H., & Axford, N. (2024) · Campbell Systematic Reviews · doi:10.1002/cl2.1376 · Cited by 3 · see citing works
e-THERAPY USING COMPUTER AND MOBILE TECHNOLOGIES IN TREATMENT
Stasiak, K., & Merry, S. (2013) · ResearchSpace (University of Auckland) · Cited by 3 · see citing works
Systems Engineering and Health Informatics
Pasupathy, K. S. (2011) · IGI Global eBooks · doi:10.4018/978-1-60960-561-2.ch606 · Cited by 2 · see citing works
Lynch, W., Platt, M. L., & Pardes, A. M. (2021) · JMIR Formative Research · doi:10.2196/30313 · Cited by 2 · see citing works
“The program uses CBT and has been shown to be evidence-based and cost-effective in treating anxiety and depression by the primary care provider [11].”
BackgroundMethodScogin, F. R., & Morthland, M. (2011) · Cited by 1 · see citing works
NURSES' ACCEPTANCE OF AN INTERNET-BASED SUPPORT SYSTEM IN THE CARE OF ADOLESCENTS WITH DEPRESSION
Kurki, M. (2014) · UTUPub (University of Turku) · Cited by 1 · see citing works
Computer-Based Brief Motivational Intervention For Medication Adherence In Schizophrenia
Kender, R. (2010) · Human Biology · Cited by 1 · see citing works
The Effectiveness of Health Informatics
Paolucci, F., Ergas, H., Hannan, T., & Aarts, J. (2010) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-61520-733-6.ch002 · Cited by 1 · see citing works
- Authors
- Cavanagh, K., Shapiro, D. A., Van den Berg, S., Swain, S., Barkham, M., & Proudfoot, J.
- Affiliations
- Newcastle University (GB)
- University of Sheffield (GB)
- University of Leeds (GB)
- UNSW Sydney (AU)
- Corresponding author
- Cavanagh, K.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2006-11
- Volume
- 45
- Issue
- 4
- Pages
- 499-514
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2061383680
- Semantic Scholar
- 5f08375b634ea5a803467d9a70abb93cb196a8de
- Cited by
- 113
- References
- 37
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 13 · 2012: 6
- FWCI
- 11.86
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- 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
- anxiety, depression, common mental disorders, stepped care, usual care, generalizability, treatment effectiveness, work and social adjustment, CORE-OM
- MeSH terms
- Adult, Aged, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Mental Health Services, Middle Aged, Periodicity, Surveys and Questionnaires, Social Adjustment, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Workplace, Intention
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