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Computer CBT for Depression Yields Lackluster Results in the Long Term

28 Oct

Researchers from the Institute of Psychiatry at Kings College, London, UK,  conducted a meta-analysis of Computerized Cognitive Behavioral Therapy (CCBT) to evaluate its short- and long-term effectiveness for treating depression.
 
Five databases were used (MEDLINE, PsycINFO, EMBASE, CENTRAL and CiNii). Investigators included all randomized, controlled trials with proper concealment and blinding of outcome assessment,  for the clinical effectiveness of CCBT in adults (aged 18 and over) with depression.
 
Using Cohen's method, the standard mean difference (SMD) for the overall pooled effects across the included studies was estimated with a random effect model. The main outcome measure and the relative risk of dropout were included in the meta-analysis.

Fourteen trials met the inclusion criteria, and sixteen comparisons from these were used for the largest meta-analysis to date. All research used appropriate random sequence generation and Intention-to-Treat analyses (ITT), and employed self-reported measures as the primary outcome. For the sixteen comparisons (2807 participants) comparing CCBT and control conditions, the pooled SMD was -0.48 [95% IC -0.63 to -0.33], suggesting similar effect to the past reviews.
 
There was no significant clinical effect at long follow-up and no improvement of function found.
 
Furthermore, a significantly higher drop-out rate was found for CCBT than for controls. When including studies without BDI as a rating scale and with only modern imputation as sensitivity analysis, the pooled SMD remained significant despite the reduction from a moderate to a small effect. Significant publication bias was found in a funnel plot and on two tests (Begg's p = 0.09; Egger's p = 0.01). Using a trim and fill analysis, the SMD was -0.32 [95% CI -0.49 to -0.16].

The investigators conclude that despite a short-term reduction in depression at post-treatment, the effect at long-term follow-up and the function improvement were not significant, with a significantly high drop-out rate.
 
Considering the risk of bias, our meta-analysis implied that the clinical usefulness of current CCBT for adult depression may need to be re-considered downwards in terms of practical implementation and methodological validity.

Citation: 
So M, Yamaguchi S, Hashimoto S, Sado M, Furukawa TA, McCrone PIs computerised CBT really helpful for adult depression?-A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry. 2013 Apr 15;13:113. doi: 10.1186/1471-244X-13-113. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award