Re: Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial
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Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial
Re: Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial
In this article authors have attempted to assess the effectiveness of computerised interventions in depression. They have concluded that the primary as well as secondary outcomes were not significantly superior. One way of looking at these results is to conclude that computerised CBT techniques are ineffective in the management of depression. On the other hand this article helps us to think about and improving the process of selecting candidates for self-help interventions. The reasons for high attrition in REEACT study could be that lack of motivation is a core feature of depressive disorders.
Computerised interventions are important self-help therapies which are available worldwide. These are used in wide range of conditions from anxiety to depression. They are also used in people with behavioural problems and eating disorders. Research on the effectiveness of self-help interventions in behavioural and eating disorders show positive results. Important factor emerging from this finding is that ‘motivation and readiness to change’ decide individuals’ engagement and positive outcome.
NICE guidance recommends the use of self-help interventions for common mental health problems. If we look at the assessment process / selection criteria, patients with common mental health problems are assessed using standard scales for particular disorders. E.g. PHQ-9 for depression and GAD-7 for anxiety. If the individuals scored above a cut off score and if the suicide or self-harm risk were low they are offered self-help interventions. Individuals readiness for change and motivation levels are not taken into consideration. One of the assumption is that including a scale to assess the motivation level or readiness to change could improve the adherence as well as positive outcomes. Future research could include these components to improve the findings. Also this will pave way for improving IAPT services.
Competing interests:
No competing interests
11 February 2017
Madhavan Seshadri
Consultant in General Adult Psychiatry
Herefordshire Recovery Services, 2gether NHS Foundation Trust.
Rapid Response:
Re: Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial
In this article authors have attempted to assess the effectiveness of computerised interventions in depression. They have concluded that the primary as well as secondary outcomes were not significantly superior. One way of looking at these results is to conclude that computerised CBT techniques are ineffective in the management of depression. On the other hand this article helps us to think about and improving the process of selecting candidates for self-help interventions. The reasons for high attrition in REEACT study could be that lack of motivation is a core feature of depressive disorders.
Computerised interventions are important self-help therapies which are available worldwide. These are used in wide range of conditions from anxiety to depression. They are also used in people with behavioural problems and eating disorders. Research on the effectiveness of self-help interventions in behavioural and eating disorders show positive results. Important factor emerging from this finding is that ‘motivation and readiness to change’ decide individuals’ engagement and positive outcome.
NICE guidance recommends the use of self-help interventions for common mental health problems. If we look at the assessment process / selection criteria, patients with common mental health problems are assessed using standard scales for particular disorders. E.g. PHQ-9 for depression and GAD-7 for anxiety. If the individuals scored above a cut off score and if the suicide or self-harm risk were low they are offered self-help interventions. Individuals readiness for change and motivation levels are not taken into consideration. One of the assumption is that including a scale to assess the motivation level or readiness to change could improve the adherence as well as positive outcomes. Future research could include these components to improve the findings. Also this will pave way for improving IAPT services.
Competing interests: No competing interests