Computerized CBT

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Computerized CBT as the name suggests, is a computerised form of Cognitive Behaviour Therapy, in which the user interacts with computer software (either on a PC, or sometimes via a voice-activated phone service), instead of face-to-face with a therapist.

Official data from the World Health Organisation shows us that annually in the UK 7.7% of the population suffer from depression and 10% from anxiety. In the United States 9.5% of the population annually suffer from depression with 18.1% of the population suffering from anxiety. However, both depression and anxiety can be successfully treated in many cases, and with Cognitive Behavioral Therapy proving to be as effective as medication (Watkins & Williams, 1998) and a popular choice for sufferers any provision of CBT on a wider basis is desirable. Hence, computerised CBT programmes may offer an opportunity to improve the lives of many people.

Use in the UK

It has been proven to be effective in randomised controlled trials, and in February 2006 the National Institute of Health and Clinical Excellence (NICE) recommended that CCBT should be made available for use within the NHS across England and Wales, for patients presenting with mild/moderate depression, rather than immediately opting for medication (i.e. anti-depressant pills). That guidance can be read here

A new Government initiative for tackling Mental Health issues, Choices In Mental Health has recently been launched by the Care Services Improvement Partnership. This confirms Primary Care Trust (PCT) responsibilities in delivering the NICE Technology Appraisal on CCBT. National Director for Mental Health, Professor Louis Appleby CBE has confirmed that by 31st March 2007 PCTs should have CCBT products in place and the NICE Guidelines should be met.

Packages available

For depression:

• Beating the Blues
• COPE
• Overcoming Depression

For anxiety:

• FearFighter

For OCD:

• OCFighter

Benefits

Computerised CBT is not a replacement for face-to-face therapy but can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. For people who are feeling depressed and withdrawn, the prospect having to speak to someone about their deepest problems can be off-putting. In this respect, CCBT (especially if delivered online) can be a good option.

The benefits to be considered are:

• Computerised CBT is clinically proven and drug-free.
• The availability of CCBT programmes increase peoples choice especially for individuals who do not want, or who are not suitable for, drug therapy or who do not wish to interact with a therapist.
• Computerised delivery of CBT can also be used to support therapist sessions.
• CCBT may be of benefit to individuals with, for example, agoraphobia and social phobias because it can be delivered at home.
• the therapy is available around the clock for people to access at their convenience. This is particularly useful for nightshift workers and people with unpredicatable schedules.
• CCBT systems also make it possible for users to repeat sessions if they wish.

Potential disadvantages

• Accurate assessment is extremely important. It must be clear that the approach is likely only to be effective for the mild to moderate group who are well motivated to make improvements.
• It is important to support people throughout the procedure, particulaly if it is not proving beneficial, to ensure that it does not compound feelings of failure and hopelessness.
• The temptation is to employ lowly and inadequately skilled personnel to run the schemes and this should be resisted as assessment and proper therapeutic support may be compromised.
• Certainly appropriate professional supervision should be made available to people running the scheme, in the context of ongoing monitoring of its appropriate use. These should be costed into proposals.

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Key texts

Papers

• Gega L, & Marks I.(2004) Computer-aided CBT self-help

for anxiety and depressive disorders: experiences of a London clinic and future directions. [[J Clin Psychol]] 60:147–57.

• Kaltenthaler,E., Brazier,J., De Nigris,E., Tumur,I., Ferriter,M., Beverley,C., Parry,G., Rooney,G., and Sutcliffe (2006) Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation.Health Technology Assessment ; Vol. 10: No. 33 Health Technology Assessment HTA NHS R&D HTA Programme

• Whitfield, Graeme and Williams,Chris (2004).If the evidence is so goood - Why doesn't anyone use them? A national survey of the use of computerized Cognitive Behaviour therapy. Behavioural and Cognitive Psychotherapy 32: 57-65 Abstract

Additional material

Papers

• Google Scholar