Computerised cognitive behaviour therapy for major depression: a reply to the REEACT trial

Area of Science:

• Psychiatry
• Digital Health
• Clinical Psychology

Background:

• Computerised cognitive behavioural therapy (CCBT) demonstrates efficacy for depression, supported by meta-analyses showing significant effect sizes and good adherence.
• A recent meta-analysis highlighted CCBT's superiority over control groups (effect size=0.86, NNT=2) with sustained benefits at follow-up.

Purpose of the Study:

• To present and discuss findings from the REEACT study comparing CCBT with usual general practitioner (GP) care for depression.
• To explore potential reasons for the lack of difference observed between CCBT and usual care groups in the REEACT study.

Main Methods:

• The REEACT study compared usual GP care against usual GP care plus access to one of two pioneering CCBT courses.
• Usual care involved extensive support, including frequent visits, medication, and psychological sessions.

Main Results:

• No significant differences in outcomes were detected between the CCBT and usual care groups in the REEACT study.
• Adherence to the CCBT courses was notably low, with only 17% engagement.
• The extensive nature of the usual care provided may have influenced the study's outcomes.

Conclusions:

• The REEACT study did not effectively test the potential of the evaluated CCBT courses in a primary care setting due to poor adherence.
• The findings suggest that the context of extensive usual care might diminish the added benefit of CCBT.
• Further research is needed to optimize CCBT delivery and adherence in primary care for depression.