title: Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial.
abstract: OBJECTIVE
  How effective is supported computerised cognitive behaviour therapy (cCBT) as an adjunct to usual primary care for adults with depression?
  
  
  METHODS
  This was a pragmatic, multicentre, three arm, parallel randomised controlled trial with simple randomisation. Treatment allocation was not blinded. Participants were adults with symptoms of depression (score ≥ 10 on nine item patient health questionnaire, PHQ-9) who were randomised to receive a commercially produced cCBT programme ("Beating the Blues") or a free to use cCBT programme (MoodGYM) in addition to usual GP care. Participants were supported and encouraged to complete the programme via weekly telephone calls. Control participants were offered usual GP care, with no constraints on the range of treatments that could be accessed. The primary outcome was severity of depression assessed with the PHQ-9 at four months. Secondary outcomes included health related quality of life (measured by SF-36) and psychological wellbeing (measured by CORE-OM) at four, 12, and 24 months and depression at 12 and 24 months.
  
  
  CONCLUSIONS
  Participants offered commercial or free to use cCBT experienced no additional improvement in depression compared with usual GP care at four months (odds ratio 1.19 (95% confidence interval 0.75 to 1.88) for Beating the Blues v usual GP care; 0.98 (0.62 to 1.56) for MoodGYM v usual GP care). There was no evidence of an overall difference between either programme compared with usual GP care (0.99 (0.57 to 1.70) and 0.68 (0.42 to 1.10), respectively) at any time point. Commercially provided cCBT conferred no additional benefit over free to use cCBT or usual GP care at any follow-up point. Uptake and use of cCBT was low, despite regular telephone support. Nearly a quarter of participants (24%) had dropped out by four months. The study did not have enough power to detect small differences so these cannot be ruled out. Findings cannot be generalised to cCBT offered with a much higher level of guidance and support.
  
  
  CONCLUSIONS
  Supported cCBT does not substantially improve depression outcomes compared with usual GP care alone. In this study, neither a commercially available nor free to use computerised CBT intervention was superior to usual GP care.
  
  
  BACKGROUND
  Commissioned and funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project No 06/43/05). The authors have no competing interests. Requests for patient level data will be considered by the REEACT trial management groupTrial registration Current Controlled Trials ISRCTN91947481.
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK simon.gilbody@york.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Littlewood
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK.
authors.forename: Gwen
authors.initials: G
authors.lastname: Brierley
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Puvan
authors.initials: P
authors.lastname: Tharmanathan
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.affiliation: Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield S10 2TP, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9NT, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: Cindy
authors.initials: C
authors.lastname: Cooper
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9NT, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: Glenys
authors.initials: G
authors.lastname: Parry
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: Andersen
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Brabyn
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9NT, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Knowles
authors.affiliation: Faculty of Health and Social Care, University of Hull, Hull HU6 7RX, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Shepherd
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Tallon
authors.affiliation: Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: David
authors.initials: D
authors.lastname: White
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods*; D006304:Health Status; D006801:Humans; D011320:Primary Health Care; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013689:Telephone; D013813:Therapy, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome