Comparative, clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety provided on a self-help basis

Abstract

Background In response to a research recommendation made by a UK healthcare policy agency (National Institute for Health and Clinical Excellence (NICE)), this study compared the effectiveness of computer-based cognitive behavioural therapy (CBT) with other self-help treatment options for mild to moderate depression and anxiety.Method Comparative, clinical feasibility study of three self-help CBT tools with six-month follow-up. Out of an initial sample of 180 adults referred by their general practitioners, 100 met the inclusion criteria and after consenting to take part were allocated one of three self-help CBT tools: the Beating the Blues® (BtB) computer programme;(1) workbooks on overcoming depression and anxiety; and the Livinglifetothefull free access internet website.(2)Results Only 50 of the 100 consented participants completed the allocated intervention protocols, however, drop-out rates were not significantly different between the groups of participants allocated each of the three self-help CBT tools. Adults aged over 24 years (χ(2) = 14.5; df = 2; P = 0.001) and with symptom duration greater than four years (χ(2) = 3.96; df = 1; P = 0.047) were significantly more likely to complete any of the three interventions. There was a highly significant reduction in mean Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) score at week eight compared to entry in all three groups (t (49) = 9.150; P ≤0.001). Adjusting for entry scores, there was no significant difference between the three groups in CORE-OM score improvement at week eight. There was no significant association between CORE-OM score improvement at week eight and number of general practitioner (GP) consultations at six months. There was no significant association between whether participants completed the programme and number of GP consultations at six months.Conclusions The results demonstrated that within a two-month follow-up period, three different tools delivering self-help CBT all produced significant clinical benefit for adults with mild to moderate depression and anxiety. The study had limited statistical power, but none of the modalities for delivering supported self-help CBT appeared superior to another. There was no evidence to suggest that any of these interventions would be likely to reduce subsequent service uptake. Nevertheless, this pilot study has shown sufficient benefit from each of the self-administered CBT tools to justify larger trials of their use.

Figure 1

Study pathway of referrals

Figure 2

Mean pre‐ and post‐CORE–OM scores