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Computer Psychotherapy in Primary Care Comes of Age: Benefits for Depression and Anxiety

Both financial and clinical benefits may accrue from providing computerized CBT to primary care patients with mixed depression and anxiety diagnoses.

Although primary care patients with depression and anxiety seem to prefer psychotherapy to medication, they may have limited access to this type of treatment due to the lack of therapists trained in evidence-based treatments. To learn more about the clinical efficacy and cost-effectiveness of computerized cognitive-behavioral therapy for depression and anxiety, these British researchers randomized 274 patients to 9 weeks of computerized CBT or to usual primary care (which could include psychotherapy referrals). Primary-care physicians could prescribe pharmacotherapy to all patients. Patients had diagnoses of depression or anxiety disorders (panic or social or specific phobias) or had mixed diagnoses.

One third of eligible patients declined to participate in the protocol; 27% of CBT recipients dropped out by the first post-treatment assessment. Over 6 months of follow-up, computerized CBT showed sustained and significantly superior effects on depression levels and on work and social functioning, as well as high patient satisfaction. On anxiety measures, effects were significant only with severe illness. In the cost-effectiveness analysis, the intervention group had higher service costs but lower costs from lost employment. If a one-unit improvement on the Beck Depression Inventory was modestly valued at 40 pounds sterling (around US$73), the intervention was shown to have a high probability (81%) of being cost-effective.

Comment: These intriguing studies document significant benefits of computerized CBT among typical primary care patients with depression and anxiety. The results are limited by the exclusive reliance on patient self-reports for outcomes; the inability to blind the treatments; and the high refusal and dropout rates, which raise doubts about the acceptability of this treatment. Perhaps, allowing therapists time to increase patient engagement and provide further individual tailoring of the treatment could improve acceptability while restraining costs.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry August 19, 2004

Citation(s):

Proudfoot J et al. Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial. Br J Psychiatry 2004 Jul; 185:46-54.

• Original article (Subscription may be required)
• Medline abstract (Free)

McCrone P et al. Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial. Br J Psychiatry 2004 Jul; 185:55-62.

• Original article (Subscription may be required)
• Medline abstract (Free)