title: Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome.
abstract: BACKGROUND
  In a recent randomized trial, we were unable to confirm the previously reported high effectiveness of CCBT. Therefore, the aim of the current study was to have a closer look at usage and acceptability (i.e. expectancy, credibility, and satisfaction) of the intervention.
  
  
  METHODS
  Depressed participants (N=200) were given login codes for unsupported online CCBT. A track-and-trace system tracked which components were used. We used a 9-month follow-up period.
  
  
  RESULTS
  Uptake was sufficient, but dropout was high. Many usage indices were positively associated with short-term depressive improvement, whereas only homework was related to long-term improvement. Acceptability was good and expectancy could predict long-term, but not short-term outcome.
  
  
  CONCLUSIONS
  Associations between use of CCBT and improvement are merely correlational. Our sample was too depressed in relation to the scope of the intervention. We relied on online self-report measures. Analyses were exploratory in nature.
  
  
  CONCLUSIONS
  Although CCBT might be a feasible and acceptable treatment for depression, means to improve treatment adherence are needed for moderately to severely depressed individuals.
authors.affiliation: Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands. E.deGraaf@dmkep.unimaas.nl
authors.forename: L Esther
authors.initials: LE
authors.lastname: de Graaf
authors.forename: Marcus J H
authors.initials: MJ
authors.lastname: Huibers
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.forename: Sylvia A H
authors.initials: SA
authors.lastname: Gerhards
authors.forename: Arnoud
authors.initials: A
authors.lastname: Arntz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult