title: Patient experience of computerised therapy for depression in primary care.
abstract: OBJECTIVE
  To explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT).
  
  
  METHODS
  Qualitative semistructured interviews with 36 participants.
  
  
  METHODS
  Depressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial.
  
  
  METHODS
  Primary care settings in England.
  
  
  RESULTS
  Participant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes.
  
  
  CONCLUSIONS
  The study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients.
  
  
  BACKGROUND
  ISRCTN91947481.
authors.affiliation: Centre for Primary Care, NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Knowles
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: Centre for Primary Care, NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Mental Health & Addiction Research Group, Department of Health Sciences, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Mental Health & Addiction Research Group, Department of Health Sciences, University of York, York, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Littlewood
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics; D036301:Qualitative Research; D013813:Therapy, Computer-Assisted / Q000379:methods*
keywords: MENTAL HEALTH; PRIMARY CARE; depression