The British Journal of Psychiatry (2009) 195: 73-80. doi: 10.1192/bjp.bp.108.054429
© 2009 The Royal College of Psychiatrists
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Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

L. E. de Graaf, MSc, S. A. H. Gerhards, MSc and A. Arntz, PhD

Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands

H. Riper, PhD

Trimbos-institute, Utrecht, The Netherlands

J. F. M. Metsemakers

Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands

S. M. A. A. Evers, PhD

Department of Health Organization, Policy and Economics, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands

J. L. Severens, PhD

Department of Health Organization, Policy and Economics, Faculty of Health, Medicine and Life Sciences, Maastricht University, and the Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands

G. Widdershoven, PhD

Department of Health, Ethics and Society/Metamedica, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands

M. J. H. Huibers, PhD

Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands

Correspondence: L. E. de Graaf, Erasmus Medical Centre, Department of Medical Psychology and Psychotherapy, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Email: l.e.degraaf{at}erasmusme.nl

Declaration of interest

None.

Funding

The trial was financed by ZonMw (Netherlands Organisation for Health Research and Development; project number 945-04-417), research institute EPP and research institute CAPHRI. Municipalities Eijsden, Meerssen, Sittard-Geleen, Valkenburg and Maastricht sponsored the study. The study sponsors had no role in the design of the study; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.

Background

Computerised cognitive–behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression.

Aims

To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care.

Method

Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period.

Results

No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses.

Conclusions

Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.


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