title: Computerised cognitive behaviour therapy for major depression: a reply to the REEACT trial.
abstract: Computerised cognitive behavioural therapy (CCBT) has been shown to be an efficacious treatment for depression. A recent meta-analysis of 9 studies showed a large mean effect size superiority over control group (effect size=0.86, number needed to treat=2), good adherence (69%) and benefits were evident at follow-up at a median of 26 weeks. In contrast, REEACT, a major study which compared usual general practitioner (GP) care versus usual GP care plus access to 1 of 2 pioneering CCBT courses detected no differences between the groups. We present the results and discuss possible explanations for these findings. In all 3 groups, usual care was extensive (9 visits in 12 months, 80% on medication, 8-23% getting psychological sessions). Adherence to CCBT courses was very poor (17%). Perhaps the surfeit of services meant there was no need for CCBT. Perhaps neither of the 2 CCBT courses encouraged adherence. What is certain is that this study did not test the potential of these CCBT courses to produce change in patients with depression presenting in primary care.
authors.affiliation: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Andrews
authors.affiliation: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Hobbs
authors.affiliation: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Newby
mesh_terms: D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy; D003865:Major Depressive Disorder; D006801:Humans; D011320:Primary Health Care; D013813:Therapy, Computer-Assisted