E-therapy may not help ease depression

Computer-assisted therapy may not be effective at easing depression in people who are already getting standard care such as counseling or medication, a U.K. study suggests.

To assess the effectiveness of computer-assisted cognitive behavioral therapy, researchers randomly sorted about 700 patients into three groups. One group received only standard care, while the other groups were offered one of two computer therapy programs in addition to usual treatment.

After four months, 44 percent of the patients receiving only standard care remained depressed, as did about 50 percent of the people who also got computer therapy.

At least part of the problem with the computer therapy is that many patients assigned to this type of supplemental care stopped using it, the study found.

"Computer technology has the potential to deliver self-help via a more interactive medium and perhaps be more accessible than other forms of self help," lead study author Simon Gilbody of the University of York in the U.K. said by email.

"The main message of our study was that engagement with the technology was very low," Gilbody added. "This does raise concerns about the use of such treatments across a range of other conditions."

Gilbody and colleagues tested two different versions of computer-assisted cognitive behavior therapy: a free program called MoodGYM and a paid option called Beating the Blues.

As reported in the BMJ, study participants were clinically depressed but they were excluded if they were suicidal, experiencing psychotic thoughts, dealing with postpartum depression or grieving the recent loss of a loved one.

Any patients in the study could receive antidepressants, counseling, psychological services or other mental health care.

The people assigned to computer therapy got technical support using the software as well as weekly phone calls to encourage them to use the software.

Beating the Blues included a 15-minute introductory video followed by eight online therapy sessions each lasting 50 minutes.

MoodGYM included five interactive modules made available on a weekly basis.

By four months, roughly one quarter of participants had dropped out of the study. Only about one in six patients completed all of their assigned computer therapy sessions.

Another shortcoming of the study is that nearly one in every five patients in the usual-care group also reported some access to computer-based treatment during the study.

Even so, the findings suggest that to the extent computer-based therapy may help, there's no advantage to paying for software because the free versions of computer therapy may work just as well as the paid ones, the authors argue.

It's also possible that computer therapy may be a better fit for people with only mild depression who express an interest in this form of treatment, Dr. Christopher Dowrick of the University of Liverpool noted in an editorial.

The computer therapy may not have performed as well in the study because participants were moderately or severely depressed rather than mildly depressed, Dowrick said by email.

"Computers (including mobile phones) are widely accessible these days, so the study definitely does point to limitations in the potential for machines to replace humans," Dowrick said.

It's also possible that the computer therapy might work if more patients were convinced to stick with this option for longer, said Madalina Sucala, a researcher at the Icahn School of Medicine at Mount Sinai who wasn't involved in the study.

"The main reason for the lack of significant differences between computerized cognitive behavioral therapy and usual care was low adherence and engagement with treatment," Sucala said by email. "If we want patients to benefit form computerized cognitive behavioral therapy we have to find a way to engage them and increase their adherence."