Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-10-31T22:43:39.812Z Has data issue: false hasContentIssue false
  • English
  • Français

Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence

Published online by Cambridge University Press:  24 September 2008

R. Waller  and
S. Gilbody
R. Waller
Affiliation:
St John's Hospital, NHS Lothian, Scotland, UK
S. Gilbody*
Affiliation:
Department of Health Sciences, University of York, York, UK
*
*Address for correspondence: Professor S. Gilbody, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK. (Email: sg519@york.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Studies of cognitive behavioural therapy delivered by computer (cCBT) show clinical efficacy for treating anxiety and depression, but have not focused on barriers to uptake. Potential barriers include adverse consequences, accessibility and acceptability.

Method

An integrated systematic review was conducted of quantitative and qualitative studies and surveys from multiple electronic databases where computers delivered cCBT for anxiety or depression.

Results

Substantial numbers of potential participants are lost prior to trials commencing with little explanation. Among trial participants, drop-outs may be higher in the cCBT groups (odds ratio 2.03, 95% confidence interval 0.81–5.09). Only a median of 56% completed a full course of cCBT and personal circumstance was a more common cause of drop-out than difficulties with the technology or social background. Risk was rarely assessed in the majority of programs. Significant staff time was needed to support clients. Therapists were more negative about cCBT than clients.

Conclusions

While cCBT is likely to be an effective and acceptable intervention for some people, there are barriers to its uptake that will substantially limit its impact if not addressed. These included investigating the outcome and attitudes of those who do not make it as far as cCBT trials and why so few finish a full course of cCBT.

Keywords

Adverse consequencescognitive behavioural therapycomputerscCBTsystematic review
Type
Review Article
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 705 - 712
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Audin, K, Bekker, HL, Barkham, M, Foster, J (2003). Self-help in primary care mental health: a survey of counsellors' and psychotherapists' views and current practice. Primary Care Mental Health 1, 89–100.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, JE, Erbaugh, JK (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bornas, X, Rodrigo, T, Barceló, F, Toledo, M (2002). New technologies in cognitive-behavioral therapy: a review. International Journal of Clinical and Health Psychology 2, 533–541.Google Scholar
Bower, P, Gilbody, S (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative Literature Review. British Journal of Psychiatry 186, 11–17.CrossRefGoogle ScholarPubMed
Bower, P, Richards, D, Lovell, K (2001). The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice 471, 838–845.Google Scholar
Carlbring, P, Ekselius, L, Andersson, G (2003). Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry 34, 129–140.CrossRefGoogle ScholarPubMed
Carlbring, P, Nilsson-Ihrfelta, E, Waaraa, J, Kollenstama, C, Buhrmana, M, Kaldoa, V, Söderberga, M, Ekselius, L, Andersson, G (2005). Treatment of panic disorder: live therapy vs. self-help via the Internet. Behaviour Research and Therapy 42, 1321–1333.CrossRefGoogle Scholar
Carlbring, P, Westling, BE, Ljungstrand, P, Ekselius, L, Andersson, G (2001). Treatment of panic disorder via the Internet: a randomized trial of a self-help program. Behavior Therapy 32, 751–764.CrossRefGoogle Scholar
Carr, AC, Ghosh, MD, Marks, I (1988). Computer-supervised exposure treatment for phobias. Canadian Journal of Psychiatry 33, 112–117.CrossRefGoogle ScholarPubMed
Christensen, H, Griffiths, KM, Korten, AE, Brittliffe, K, Groves, C (2004). A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research 6, e46.CrossRefGoogle ScholarPubMed
Churchill, R, Hunot, V, Corney, R, Knapp, M, McGuire, H (2001). A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment 5, 1–173.Google ScholarPubMed
Clarke, G, Reid, E, Eubanks, D, O'Connor, E, DeBar, LL, Kelleher, C, Lynch, F, Nunley, S (2002). Overcoming Depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program. Journal of Medical Internet Research 4, e14.CrossRefGoogle Scholar
Cuijpers, P (1997). Bibliotherapy in unipolar depression. Behaviour Therapy and Experimental Psychiatry 28, 139–147.CrossRefGoogle ScholarPubMed
Department of Health (2001). Treatment Choice in Psychological Therapies and Counselling. Evidence-based clinical practice guideline. Department of Health: London.Google Scholar
Department of Health (2002). Guidance on the Use of computerised Cognitive Behavioural Therapy for Anxiety and Depression. Technology Appraisal Guidance. National Institute for Clinical Excellence. Department of Health: London.Google Scholar
Department of Health (2006). Guidance on the Use of Computerised Cognitive Behavioural Therapy for Anxiety and Depression. Technology Appraisal Guidance. National Institute for Clinical Excellence. Department of Health: London.Google Scholar
Dixon-Woods, M, Fitzpatrick, R (2001). Qualitative research in systematic reviews. British Medical Journal 323, 765–766.CrossRefGoogle ScholarPubMed
Fox, E, Acton, T, Wilding, B, Corcoran, S (2004). Service development report: an assistant psychologist's perspective on the use of computerised CBT in a GP practice in Barnet. Quality in Primary Care 12, 165–168.Google Scholar
Gega, L, Marks, I (2004). Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. Journal of Clinical Psychology 60, 147–157.CrossRefGoogle ScholarPubMed
Gilroy, L, Kirkby, KC, Daniels, BA, Menzies, RG, Montgomery, IM (2000). Controlled comparison of computer-aided vicarious exposure versus live exposure in the treatment of spider phobia. Behavior Therapy 31, 733–744.CrossRefGoogle Scholar
Gilroy, L, Kirkby, KC, Daniels, BA, Menzies, RG, Montgomery, IM (2003). Long-term follow-up of computer-aided vicarious exposure versus live graded exposure in the treatment of spider phobia. Behavior Therapy 34, 65–76.CrossRefGoogle Scholar
Gould, RC (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review 13, 169–186.CrossRefGoogle Scholar
Graham, C, Franses, A, Kenwright, M, Marks, I (2000). Psychotherapy by computer: a postal survey of responders to a teletext article. Psychiatric Bulletin 24, 331–332.CrossRefGoogle Scholar
Grime, PR (2001). An Open, Randomised Study, to Compare the Effects of a Computerised Cognitive Behavioural Therapy Programme (‘Beating the Blues’) plus Conventional Care, vs Conventional Care Alone, on Absence from Work due to Anxiety, Depression or Stress. An Attempt to Evaluate a Workplace Intervention for Stress. Faculty of Occupational Medicine, Royal College of Physicians: London.Google Scholar
Grime, PR (2004). Computerized cognitive behavioural therapy at work: a randomised controlled trial in employees with recent stress-related absenteeism. Occupational Medicine 54, 353–359.CrossRefGoogle Scholar
Heading, K, Kirkby, KC, Martin, F, Daniels, BA, Gilroy, LJ, Menzies, RG (2001). Controlled comparison of single-session treatments for spider phobia: live graded exposure alone versus computer-aided vicarious exposure. Behaviour Change 18, 103–113.CrossRefGoogle Scholar
Ioannidis, JP, Chew, P, Lau, J (2002). Standardized retrieval of side effects data for meta-analysis of safety outcomes. A feasibility study in acute sinusitis. Journal of Clinical Epidemiology 55, 619–626.CrossRefGoogle ScholarPubMed
Kaltenthaler, E, Brazier, J, De Nigris, E, Tumur, I, Ferriter, M, Beverley, C, Parry, G, Rooney, G, Sutcliffe, P (2006). Computerised cognitive behavioural therapy for anxiety and depression update: a systematic review and economic evaluation. Health Technology Assessment 10, 1–168.CrossRefGoogle ScholarPubMed
Kaltenthaler, E, Shackley, P, Stevens, K, Beverley, C, Parry, G, Chilcott, J (2002). A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment 6, 1–89.CrossRefGoogle ScholarPubMed
Lewis, G, Anderson, L, Araya, R, Elgie, R, Harrison, G, Proudfoot, J, Schmidt, U, Sharp, D, Weightman, A, Williams, C (2003). Self-help Interventions for Mental Health Problems. Report to the Department of Health R&D Programme. Department of Health: London.Google Scholar
Lovell, K, Richards, D (2000). Multiple access points and levels of entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy 28, 379–391.CrossRefGoogle Scholar
Marks, IM, Kenwright, M, McDonough, M, Whittaker, M, Mataix-Cols, D (2004). Saving clinicians' time by delegating routine aspects of therapy to a computer: a RCT in phobia/panic disorder. Psychological Medicine 34, 9–18.CrossRefGoogle Scholar
Marks, IM, Mataix-Cols, D, Kenwright, M, Cameron, R, Hirsch, S, Gega, L (2003). Pragmatic evaluation of computer-aided self-help for anxiety and depression. British Journal of Psychiatry 183, 57–65.CrossRefGoogle ScholarPubMed
Marrs, R (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology 23, 843–870.CrossRefGoogle ScholarPubMed
McCrone, PM, Knapp, M, Proudfoot, J, Ryden, C, Cavanagh, K, Shapiro Ilson, S, Gray, JA, Goldberg, D, Mann, A, Everitt, B, Tylee, A (2004). Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 55–62.CrossRefGoogle ScholarPubMed
Moher, D, Cook, DJ, Eastwood, S, Olkin, I, Rennie, D, Stroup, DF, for the QUOROM Group (1999). Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354, 1896–1900.CrossRefGoogle ScholarPubMed
Moher, D, Schulz, KF, Altman, DG (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357, 1191–1194.CrossRefGoogle Scholar
Newman, MG (1997). Comparison of palmtop-computer-assisted brief cognitive-behavioural treatment to cognitive-behavioural treatment for panic disorder. Journal of Consulting and Clinical Psychology 65, 178–183.CrossRefGoogle Scholar
Newman, MG (1999). The clinical use of palmtop computers in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice 6, 222–234.CrossRefGoogle Scholar
Newman, MG, Consoli, AJ, Taylor, CB (1999). A palmtop computer program for the treatment of generalized anxiety disorder. Behavior Modification 23, 597–619.CrossRefGoogle ScholarPubMed
NHS Centre for Reviews and Dissemination (2001). Undertaking Systematic Reviews of Research on Effectiveness: CRD report 4 (2nd edn). University of York: York.Google Scholar
Office for National Statistics (2006). Labour Force Survey 2006, Education and Training Statistics. Office for National Statistics: London.Google Scholar
Osgood-Hynes, DJ, Greist, JH, Marks, IM, Baer, L, Heneman, SW, Wenzel, KW, Manzo, PA, Parkin, JR, Spierings, CJ, Dottl, SL, Vitse, HM (1998). Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open U.S.–U.K. study. Journal of Clinical Psychiatry 59, 358–365.CrossRefGoogle ScholarPubMed
Proudfoot, J, Goldberg, D, Mann, A, Everitt, B, Marks, I, Gray, JA (2003 a). Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychological Medicine 33, 217–227.CrossRefGoogle ScholarPubMed
Proudfoot, J, Ryden, C, Everitt, B, Shapiro, D, Goldberg, D, Mann, A, Tylee, A, Marks, I, Gray, JA (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 46–54.CrossRefGoogle ScholarPubMed
Proudfoot, J, Swain, S, Widmer, S, Watkins, E, Goldberg, D, Marks, I, Mann, A, Gray, JA (2003 b). The development and beta-test of a computer-therapy program for anxiety and depression: hurdles and lessons. Computers in Human Behavior 19, 277–289.CrossRefGoogle Scholar
Scogin, F, Stephens, G, Calhoon, S (1990). Efficacy of self-administered programs: meta-analytic review. Professional Psychology: Research and Practice 21, 42–47.CrossRefGoogle Scholar
Selmi, PM, Klein, MH, Greist, JH, Sorrell, SP, Erdman, HP (1990). Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry 147, 51–56.Google ScholarPubMed
Thomas, J, Harden, A, Oakley, A, Oliver, S, Sutcliffe, K, Rees, R, Brunton, G, Kavanagh, J (2004). Integrating qualitative research with trials in systematic reviews. British Medical Journal 328, 1010–1012.CrossRefGoogle ScholarPubMed
White, J, Jones, R, McGarry, E (1998). Self-administered psychotherapy for the anxiety disorders: a pilot study. Journal of Mental Health 7, 358–365.Google Scholar
White, J, Jones, R, McGarry, E (2000). Cognitive behavioural computer therapy for the anxiety disorders: a pilot study. Journal of Mental Health 9, 505–516.Google Scholar
Whitfield, G, Hinshelwood, R, Pashely, A, Campsie, L, Williams, C (2006). The impact of a novel computerised CBT CD Rom (Overcoming Depression) offered to patients referred to clinical psychology. Behavioural and Cognitive Psychotherapy 34, 1–11.CrossRefGoogle Scholar
Whitfield, G, Williams, C (2004). If the evidence is so good – why doesn't anyone use them? A national survey of the use of computerized cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy 32, 57–65.CrossRefGoogle Scholar
Williams, C, Garland, A (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment 8, 172–179.CrossRefGoogle Scholar
Supplementary material: File

Waller Supplementary Material

Appendix.doc

Download Waller Supplementary Material(File)
File 343.6 KB