The benefits of online do-it-yourself treatments for depression have been called into question by a new study out of the U.K. that finds people quit the programs too soon, largely due to difficulties of repeatedly logging on to computer systems when clinically depressed.
Scientists at the University of York found that computer-assisted cognitive behavioral therapy, or cCBT, was no more effective in treating depression than the usual care patients receive from a general practitioner. It is the largest trial to date on cCBT.
Traditional cognitive behavioral therapy is a form of talk therapy that has been proven to be an extremely useful tool in tackling depression, an immensely common disease and the leading cause of disability worldwide. Rather than exploring a patient’s past, a trained therapist focuses on a person’s thought patterns and how they affect his or her behavior. But such medical care is not always immediately available, particularly in rural areas, so the hope was that computer-assisted therapy could step in to fill the void.
The York researchers say the findings serve as a reminder that the Internet isn’t a panacea for mental health problems and suggest that clinicians and policymakers might want to rethink the computer’s role in therapy. They said the online therapy failed to hit the mark because patients did not engage with the computer programs on a sustained basis despite being offered a high level of technical support and weekly phone calls encouraging participation.
No Substitute for Doctors and Therapists
“We do still need the human touch or the human interaction, particularly when people are depressed,” Christopher Dowrick, a professor of primary medical care at the University of Liverpool, wrote in an editorial accompanying the paper. “It’s an important, cautionary note that we shouldn’t get too carried away with the idea that a computer system can replace doctors and therapists.”
For the study, the research team enrolled 691 depressed patients to assess the effectiveness of the commercial “Beating the Blues” program and the free-to-use “MoodGYM,” assessing each person’s depression and health-related quality of life at four, 12 and 24 months. Their results showed that cCBT offered little or no benefit over normal treatment by a general practitioner. Only 18% of patients completed all eight sessions of Beating the Blues, and 16% completed all six sessions of MoodGYM. Almost one-quarter of the patients dropped out of the study by four months.
“Participants wanted a greater level of clinical support as an adjunct to therapy, and in absence of this support, they commonly disengaged with the computer programs,” the study authors said.
It’s important to note, however, that previous studies have shown Web-based therapy does produce benefits when conducted by specialists (secondary care providers) who guide participants through the computer packages. It has also been shown to provide relief to people with only mild depression symptoms.
Similar Outcome With Anxiety
The York researchers’ results mirror those of studies on anxiety, in which researchers have found that people who purchase self-help books and Web-based materials on anxiety typically fail to complete the programs. A 2013 review by the London-based Cochrane Collaboration, an independent scientific group, notes that when it comes to anxiety disorders, a face-to-face meeting with a therapist is most likely superior to self-help books and apps but that “self-help is probably better than no treatment.”
The Centers for Disease Control and Prevention estimates that 9% of adult Americans have feelings of hopelessness, worthlessness or guilt that generate a diagnosis of depression, while about 3% have major depression, also known as major depressive disorder, a long-lasting and severe form of depression. Women are 70% more likely than men to experience depression over the course of their lifetimes. Even more people suffer with anxiety, with an estimated 18% of adults said to experience the condition in any given year. The statistics also show that about one in four people in America and Europe has a treatable mental disorder, but up to three-quarters don’t seek help, citing reasons such as embarrassment, an inability to pay for treatment or a lack of access to mental health providers.
And there’s the bottom line. Online treatment for depression or anxiety is worth looking into, experts say, if you can’t find a therapist to help or can’t afford one. But you’ll need to be very disciplined and follow through with the materials.
Being depressed can mean being “lost in your own little small, negative, dark world,” Dowrick told Kaiser Health News. Having a person, instead of a computer, on your side is vital in combating the tendency to withdraw. “When you’re emotionally vulnerable, you’re even more in need of a caring human being,” he said.
By Laura Nott
Computerised Self Help for Depression in Primary Care
Computerised Cognitive Behaviour Therapy (cCBT) as Treatment for Depression in Primary Care (REEACT trial): Large Scale Pragmatic Randomised Controlled Trial
Cognitive Behavior Therapy via the Internet: a Systematic Review of Applications, Clinical Efficacy and Cost-Effectiveness.
Depressed? Look For Help From a Human, Not a Computer