National Institute of Health Research

HTA - 06/43/05: A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

Project title A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial
Research type Primary Research
Status Project complete
Start date May 2009
Publication date

December 2015

Link to journal publication
Cost £ 1,621,924.00
Chief Investigator Professor Simon Gilbody
Co-investigators Professor Ricardo Araya (University of Bristol), Professor Michael Barkham (University of Sheffield), Professor Peter Bower (The University of Manchester), Professor Cindy Cooper (University of Sheffield), Professor Linda Gask (The University of Manchester), Dr David Kessler (University of Bristol), Professor Helen Lester (The University of Manchester), Ms Nicola Lidbetter, Professor Karina Lovell (The University of Manchester), Professor Stephen Palmer (University of York), Professor Glenys Parry (University of Sheffield), Professor David Richards (Institute of Health Services Research, University of Exeter), Professor Mark Sculpher (University of York), Professor David Torgerson (University of York)
Contractor University of York
Plain English summary A substantial proportion of people with depression would like receive a 'talking treatment' (counselling or psychotherapy). The form of talking treatment that is supported by the greatest amount of research evidence of effectiveness is Cognitive Behaviour Therapy (CBT). At the present time, there are too few therapists to treat people with depression. Recently, a form of CBT has been developed that can be delivered by computer. Computerised CBT can be delivered in the patients own time (and potentially in their own home) and does not require waiting for a therapist. Several computer packages of CBT have been developed. Some of these are free to use and are available over the internet, whilst some are commercial products and they will have to be purchased at substantial cost to the NHS. We need more information about the effectiveness of these packages and we need to know whether the additional cost of purchasing commercially available products is a sensible use of limited NHS funds. We propose to conduct a fair test of two CBT packages compared to usual GP care alone. We will examine whether computerised forms of CBT are effective in reducing the symptoms of depression and in improving quality of life and helping people with depression to resume work or caring. We will also examine whether expensive commercial products are any better than freely available programmes, and whether the extra cost is justified. Computerised CBT involves interaction with a computer rather than a trained therapist. Although computers have increasingly become part of modern life, it remains unclear how acceptable this form of treatment is for people with depression. We will examine whether people with little of no experience of computers find this form of treatment acceptable, and whether the treatment can be realistically offered in the patients own home or in a GP surgery. We will list the principle concerns that will need to be overcome if computerised therapy is to be adopted more widely in the NHS, following the completion of this trial.
Scientific summary Depression is a major health problem. The majority of people with depression receive care from their GP. However, lots of people experiencing depression would also like to receive a "talking treatment" (counselling or psychotherapy). Cognitive Behaviour Therapy (CBT) seems to be the most effective type of talking treatment for depression but is not always immediately available in the NHS. Recently, therapists have developed a form of CBT that can be delivered by computer, which might make it easier to access this form of treatment. We call this "computerised CBT". There are different computerised packages, some of which are freely available and others which have to be paid for by the NHS. At the moment we do not know which of these works best for NHS patients with depression. The purpose of this study is to compare two (one free-to-use and one commercial) CBT packages to see if there are any additional benefits of offering this treatment to the care that people already receive from their GP. We will also examine whether the commercial package is better than the free-to-use package and whether the extra cost is justified. To answer these questions, we will randomly allocate 600 participants to receive either usual GP care alone, usual GP care plus a commercial CBT package, or usual GP care plus a free-to-use package. We will compare how people fare and the costs of the different options. We will recruit participants via their GP Practice in four centres (York, Sheffield, Bristol and Manchester) and follow them up for two years. It is also unclear how acceptable this form of treatment is for people with depression. We will examine this issue, and how it should be delivered in the NHS, by discussions with NHS staff and the patients participating in the trial.
Project website www.reeact.org.uk/
Outputs
  1. Using short information leaflets as recruitment tools did not improve recruitment: a randomized controlled trial

    Authors: Brierley, G; Richardson, R; Torgerson, DJ

    Reference: Journal of Clinical Epidemiology 2011;doi:10.1016/j.jclinepi.2011.06.005

Documents

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