Development and Evaluation of a Computer-Based Cognitive-Behaviour Therapy
Programme for the Treatment of Anxiety and Depression in Primary Care

Dr Judy Proudfoot

The research programme has the following aims:

1. To develop a computer-interactive cognitive-behaviour therapy programme for the treatment of anxiety and depression in primary care
2. To conduct a randomised-controlled trial to compare the effectiveness of the computer therapy programme against routine GP care for anxiety and depression with and without medication.

Computer-based therapy offers the following advantages:
o Can be made widely available, allowing more patients to be treated with cognitive~-behaviour therapy
o Cost-effectiveness, saving drug and personnel costs
o Generally high acceptance from patients (there is some evidence to show that patients even prefer it to face-to-face treatment when problems are of a sensitive nature)
o Patients can work at their own pace
o Time-efficient
o Techniques can be standardised
o An alternative to medication for patients who are reluctant to take drugs
o In-built patient monitoring
o Has been shown to be as effective as other forms of treatment

1. Development of computer-interactive therapy programme 'Beating the Blues' The programme development is now completed. In conjunction with Ultramind, a software company specialising in interactive healthcare programming, an 8-session multi-media cognitive-behavioural therapy programme has been developed. 'Beating the Blues' aims to help patients firstly to identify, and then to change dysfunctional ways of thinking, and to learn more effective ways of solving problems. The sessions, of 50 minutes duration, are designed to be completed at either mental health or GP clinics, with minimal supervision from a practice nurse or other member of the primary health care team. A progress report is printed out each session for the patient's GP.

2. Evaluation of the effectiveness of the computer-based therapy programme
A pilot study involving 17 patients in a number of GP practices in Manchester and London has now been completed. The results look promising. Self-rated measures of anxiety and depression by patients showed improvement from the first to the last (eighth) session (see graph below), and patients' feedback was, in the main, very positive. Typical patient comments included:

'The programme encourages self-help.'

It shows videos of people with the same problems as yourself how they get themselves back on the road to recovery.'

'It was easy to understand.'

'I liked being helped to set my goals and I found it useful to record things like sleeping patterns and daily activities'

I liked the homework activities because they got your brain working - I always had something to do and they helped me to cope better.'

'The calm, though systematic approach to the problem resolution was the key.'

'Working at my own pace, being on my own and not feeling embarrassed by what I was feeding into the computer was good.'

A full clinical trial is about to commence. Two hundred anxious/depressed patients aged 18-75, who score 4 or more on the GHQ12 and 12 or more on the Clinical Interview Schedule-R, and who do not have a psychotic disorder, organic mental disorder or drug/alcohol dependence, will be recruited into the trial from 5 MIRC GP Framework practices. Half will be taking medication for anxiety/depression (the patient's GP will make the decision as to whether medication is to be prescribed). Within each of these two cells (drugs / no drugs), patients will be randomly allocated to two conditions: computer-therapy programme or routine GP care. Computerised ratings will be taken of patients' depression, anxiety, global adjustment, work adjustment, social adjustment and attributional style. Health service usage will also be measured. Measures will be taken before and after treatment, and at 1,3 and 6 months follow-up.