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Online CBT is no more effective than usual GP care for depression

discover.dc.nihr.ac.uk

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Re: Online CBT is no more effective than usual GP care for depression

#3

Post by 0xcde4c3db »

As I recall, some influential people in NICE and/or the NHS really wanted this to work because it's vastly cheaper and more available than in-person CBT. This result is consistent with a longstanding but controversial hypothesis that the overall quality of the therapist-client relationship is far more important than the nuts and bolts of whatever theory the therapist follows [1].

[1] https://en.wikipedia.org/wiki/Dodo_bird_verdict

Re: Online CBT is no more effective than usual GP care for depression

#4

Post by languagewars »

I played with a free online cbt and got much further than their average participant in this study.. I'm not sure if there is any use to cbt for depression, but I would suspect that it would work better in a preventative fashion.

I.e. I did notice that I can let thinking about some social interactions go where they would bother me in the past, but if I was depressed when I played with it, then maybe I would just notice how bad I was at benefiting from CBT at the moment where I should be letting something go.

Re: Online CBT is no more effective than usual GP care for depression

#5

Post by df3 »

The study did not seem to separate the results of those who completed online CBT from the majority who did not.

An interesting excerpt: "Take-up of computerised CBT was low, despite regular calls to encourage participants to use the programmes. The median number of sessions completed was two out of eight for Beating the Blues and one out of six for MoodGYM. Only 18% of people who started Beating the Blues completed all modules and 16% for MoodGYM."

Online CBT definitely is not effective if patients don't complete it despite receiving phone calls. I can imagine that getting the motivation to log in and do it is really difficult when you're already feeling hopeless-- even not-depressed people have enough trouble building and sticking to habits as it is.

But I still wonder if online CBT was effective for the small portion of participants who did complete it? What were the characteristics of those who did complete the app? Perhaps we can learn something.

CBT app builders should also consider that self-care options for depression have existed for a long time in the form of books. Can an app do a substantially better job than books? The idea of solving medical issues remotely has been tried for decades.

Re: Online CBT is no more effective than usual GP care for depression

#8

Post by grkvlt »

tshtf wrote: post #6

Couldn't the headline read: "Online CBT as effective as usual GP care for depression"?

Yes, that seems like a much more useful takeaway (at least, assuming that the usual standard of GP care is better than a sugar-pill placebo twice daily; shouting things at a brick wall; playing with kittens; and even 'folk' remedies like pouring a mixture of garlic, powdered chilli, raw eggs and old yoghurt down your trousers.)

If so, then it seems like you could replace expensive (for the NHS, and therefore the taxpayer) one-to-one consultation sessions with visiting a website on your phone/tablet/whatever. It frees up doctor time for other patients, or just allows them to pursue other parallel avenues of treatment with the same patient. In fact it would probably also have the side benefit that, because there is none of the stigma or awkwardness associated with going to a doctor for mental health problems, more people are likely to try and get their problems sorted out.

Generally a win all round?

EDIT OK, I read the article after seeing the sibling comment, and the online CBT is in addition to the usual GPs treatment; sadly not the amazing win that I thought ;( I should trust the headline writers more, but unfortunately buzzfeed and their click-baity ilk have trained me to have a certain wariness and skepticism these days!

Re: Online CBT is no more effective than usual GP care for depression

#9

Post by DanBC »

df3 wrote: post #5

The study did not seem to separate the results of those who completed online CBT from the majority who did not. An interesting excerpt: "Take-up of computerised CBT was low, despite regular calls to encourage participants to use the programmes. The median number of sessions completed was two out of eight for Beating the Blues and one out of six for MoodGYM. Only 18% of people who started Beating the Blues completed a…

> But I still wonder if online CBT was effective for the small portion of participants who did complete it?

MoodGym and Beating the Blues have some evidence behind them. NICE was recommending Beating the blues because they have some evidence of efficacy for it.

Maybe there's a simple fix. Something like Flo to keep people engaged with it, or some kind of gamifaction.

http://www.health.org.uk/flo

Or maybe Recovery College combined with online CBT?

http://www.health.org.uk/recovery-college

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