Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open U.S.-U.K. study.
OBJECTIVE
To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response (IVR) system.


METHODS
In an open trial, 41 patients from Boston, Massachusetts; Madison, Wisconsin; and London, England, used COPE, a 12-week self-help system for depression. COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered.


RESULTS
All 41 patients successfully completed the self-assessment in the booklets and telephone calls; 28 (68%) also completed the 12-week self-help program. Hamilton Rating Scale for Depression (HAM-D) and Work and Social Adjustment scores improved significantly (41% and 42% mean reduction in the intent-to-treat sample, respectively, p < .001). Eighteen (64%) of the 28 completers were considered responders on the basis of > or = 50% reduction in their HAM-D scores. There was a higher percentage of completers in the pooled U.S. sites (82% vs. 43%), and U.S. completers improved more than those in the United Kingdom (73% vs. 43% were responders). Most (68%) of the calls were made outside usual office hours, Monday-Friday, 9:00 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls (more treatment modules) correlated positively with improvement over 12 weeks. Mean call length for completers was 14 minutes.


CONCLUSIONS
A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with mild-to-moderate depression. These preliminary results are encouraging for people who cannot otherwise access ongoing, in-person therapy.
Massachusetts General Hospital and Harvard Medical School, Boston, USA. os-hynes@psych.mgh.harvard.edu
D J
DJ
Osgood-Hynes
J H
JH
Greist
I M
IM
Marks
L
L
Baer
S W
SW
Heneman
K W
KW
Wenzel
P A
PA
Manzo
J R
JR
Parkin
C J
CJ
Spierings
S L
SL
Dottl
H M
HM
Vitse
D000328:Adult; D000368:Aged; D001900:Boston; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods*; D019114:Remote Consultation; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D013689:Telephone; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D014481:United States; D014743:Videotape Recording