An article in this week’s Global Mental Health special edition of The Lancet reports that Cognitive behavioural therapy (CBT) seems to be efficient when delivered online in real time by a therapist. The benefits are maintained over eight months. This technique of delivery could expand access to CBT in primary care. The article is the work of Dr David Kessler, NIHR National School for Primary Care Research, University of Bristol, UK, and colleagues.
CBT remains difficult to access because there is a need for trained therapists. There is strong confirmation of its effectiveness. Computerised programmes have been developed to improve accessibility. However it is unclear whether these interventions are responsive to individual needs. The authors investigated the effectiveness of online CBT for patients with depression in primary care.
A total of 297 patients were recruited from 55 general practices in Bristol, London, and Warwickshire, UK for this randomised controlled trial. They all had a confirmed diagnosis of depression. In the intervention group, 149 patients received online CBT in addition to usual care. In the control group, 148 patients received usual care from their general practitioner while on an eight month waiting list for online CBT. The primary outcome was recovery from depression after four months.
Results indicated that 113 patients in the intervention group and 97 in the control group completed the four month follow-up. 38 percent of patients recovered from depression in the intervention group versus 24 percent in the control group after four months. After eight months, the proportions of patients that had recovered were 42 percent in the intervention group and 26 percent in the control group.
The authors write in conclusion: “The number of patients for whom online CBT is feasible and attractive will grow. It could be useful in areas where access to psychological treatment is scarce, and for patients whose first language is not English. It could make access to psychotherapies more equitable by providing a service to patients in areas or even countries where psychological treatment is not readily available. Real-time online CBT offers the flexibility and responsiveness of face-to-face CBT and is appropriate for people with severe symptoms. It affords an opportunity for reflexion and review as part of the therapeutic process, which could enhance its effectiveness.”
In an associated note, Dr Gregory E Simon and Dr Evette J Ludman, of the Group Health Research Institute, Seattle, WA, USA, explain that new communications technologies will challenge some conventional notions about the fundamentals of psychotherapy. For instance, they would allow everyday contacts instead of one hour consultations every 1 to 2 weeks. They say in closing: “Traditional therapists might be horrified by the prospect of an overseas cognitive-behavioural call centre or live-chat centre, available whenever patients choose. But the expectations of health-care providers are not the same as evidence. And the evidence that matters concerns clinical benefit and economic value to patients, rather than appeal or value to providers.”
“Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial”
David Kessler, Glyn Lewis, Surinder Kaur, Nicola Wiles, Michael King, Scott Weich, Debbie J Sharp, Ricardo Araya, Sandra Hollinghurst, Tim J Peters
Lancet 2009; 374: 628-34
Written by Stephanie Brunner (B.A.)