Computerized Cognitive Behavioral Therapy for Adults with Depressive or Anxiety Disorders (original) (raw)
Related papers
2011
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Translational behavioral medicine, 2011
Combat exposure among military personnel results in increased risk of posttraumatic stress disorder (PTSD), major depression, substance use, and related health risks. PTSD symptoms require innovative approaches to promote effective coping postdeployment. PTSD's nature and scope requires an approach capable of integrating multiple health risks while reaching large populations. This article provides the rationale and approach to adapt and evaluate a Pro-Change computerized tailored intervention (CTI) targeted at behavioral sequelae (i.e., smoking, stress, and depression) for veterans with or at risk for PTSD. The three-phase approach includes: 1) focus groups to review and, subsequently, adapt content of the existing CTI programs; 2) usability testing; and 3) feasibility testing using a three-month pre-postdesign. Effective, theory-based, real-time, multiple behavior interventions targeting veterans' readiness to quit smoking, manage stress, and depression are warranted to pro...
Frontiers in Public Health
BackgroundThe US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD).MethodsThis study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we cond...
Computers in Human Behavior, 2003
This paper describes the development and beta-test of an eight-session computer therapy program for anxiety and depression, ‘Beating the Blues’. Developed by a multi-functional team, the program uniquely combines multi-media interactive computer technology with empirically-validated cognitive-behavioral therapy (CBT) techniques and crucial non-specific aspects of therapy. The paper describes how the project proceeded through its development phase, the unexpected hurdles that occurred and the lessons learnt. As an integral part of the development, the program was beta-tested with 20 patients. Despite the small numbers and the fact that the eight sessions were completed at an accelerated rate, feedback was positive. Patients reported it was helpful, easy to use, and of those who had had previous treatment for their problems, the majority indicated it compared at least as well as other forms of therapy. The beta-test also highlighted where changes were needed to the program. These were implemented prior to release of the program for the next phase of testing. Lastly, the beta-test indicated that the program had sufficient promise for it to be evaluated formally by randomized controlled trial.
Objective: To examine evidence for the effectiveness of computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care and assess the impact of therapist-supported CCBT versus self-guided CCBT. Methods: A search for randomized studies of CCBT compared to control groups for treating depression in primary care settings was conducted using Ovid MEDLINE, PsycINFO, PubMed, and Scopus. We extracted the following information from the studies that met inclusion criteria: mean depression rating scale scores before and after treatment, number of patients, type of control group and CCBT program, therapist support time and method of support, and treatment completion rate. Meta-analyses compared differences between posttreatment mean scores in each condition, as well as mean scores at follow-up. Study quality and possible bias also were assessed. Results: Eight studies of CCBT for depression in primary care met inclusion criteria. The overall effect size was g = 0.258, indicating a small but significant advantage for CCBT over control conditions. Therapist support was provided in 4 of the 8 studies. The effect size for therapist-supported CCBT was g = 0.372—a moderate effect. However, the effect size for self-guided CCBT was g = 0.038, indicating little effect. Conclusions: Implementation of therapist-supported CCBT in primary care settings could enhance treatment efficiency, reduce cost, and improve access to effective treatment for depression. However, evidence to date suggests that self-guided CCBT offers no benefits over usual primary care.
Computerised cognitive-behavioural therapy for depression: systematic review
The British Journal of Psychiatry, 2008
Depression and anxiety are common mental disorders usually treated within a primary care setting in the UK. Recognition of both disorders by general practitioners is often poor and the proportion of individuals who actually receive treatment is low. 1 Currently, medication is usually the first and often the only treatment offered, but is often associated with unwanted effects and is not cost-effective in those people with negative attitudes to taking medication. 2 There is substantial evidence to support the use of psychological therapies, particularly cognitive-behavioural therapy (CBT) in the treatment of depression and anxiety. In common with all psychological therapies, there are considerable problems in the delivery of CBT in the UK, including too few therapists, expense associated with service costs, waiting lists and peoples' reluctance to enter therapy. Recently there have been suggestions that self-help strategies are useful tools for delivering psychological therapies. 6 Alternative delivery methods for CBT with less therapist involvement have been developed including computerised cognitive-behavioural therapy (CCBT). Although a variety of non-randomised uncontrolled studies of CCBT have been reported in the literature, 7-9 these studies are of poorer quality compared with randomised controlled trials and are potentially biased in favour of the treatment under investigation. This paper systematically reviews randomised controlled trials of CCBT software packages for the treatment of mild to moderate depression.
Computerized cognitive behaviour therapy: a systematic review
2004
Abstract. Depression, anxiety disorders and phobias are common mental health problems associated with considerable occupational and interpersonal impairment. Although there is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of these disorders, access is limited. Computerized cognitive behaviour therapy (CCBT) is one of a variety of aids to self-management that offer patients the potential benefits of CBT with less therapist involvement than therapist led CBT (TCBT).
Contemporary Clinical Trials, 2014
Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed.
Computer-delivered cognitive behavioural therapy: effective and getting ready for dissemination
F1000 Medicine Reports, 2010
Computer-delivered cognitive behavioural therapy (CCBT) is emerging as a promising strategy for improving access to mental health services. Randomized controlled trials have confirmed the efficacy of guided CCBT in treating depression, generalized anxiety disorder, panic disorder, social phobia, and other common mental disorders. With proper guidance, effect sizes are comparable to those obtained in face-to-face cognitive behavioural therapy, treatment is cost-effective, and preliminary data indicate that CCBT is acceptable to patients. Trials are beginning to evaluate optimal strategies for integrating CCBT within existing systems of mental health care.
Annals of the New York Academy of Sciences, 2010
Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting psychological difficulties as well as frequent long distances to treatment facilities reduce many veterans' willingness and ability to receive care. Telemedicine and virtual human technologies offer a unique potential to expand services to those in greatest need. Telemedicine-based treatment has been used to address multiple psychiatric disorders, including posttraumatic stress disorder, depression, and substance use, as well as to provide suicide risk assessment and intervention. Clinician education and training has also been enhanced and expanded through the use of distance technologies, with trainees practicing clinical skills with virtual patients and supervisors connecting with clinicians via videoconferencing. The use of these innovative and creative vehicles offers a significant and as yet unfulfilled promise to expand delivery of high-quality psychological therapies, regardless of clinician and patient location.