Question: In adults with mild to moderate depression, how effective is computerised cognitive behavioural therapy (CCBT) compared with traditional cognitive behavioural therapy (CBT) (face to face, group or individual), in improving patient outcomes?

Answer:

Moderate quality evidence from five RCTs found that there was no difference between CCBT and traditional CBT. However, most of these trials were small (36 to 69 participants) which may explain why no statistically significant differences were seen between the groups. The only larger trial (201 participants) aimed to explore which participant factors were predictive of treatment outcomes, and was not a report of the main trial results. Following on from the NICE recommendations, this indicates that CCBT is an alternative treatment option, but factors such as the cost, participant's access to a computer and their preferences for treatment (some may prefer to use the computer, others may prefer to speak to a professional) should be considered.

Given the small sample sizes and lack of blinding in most of the existing trials, a larger-scale RCT is needed. This should be adequately powered to measure depression outcomes, with a suitable period of follow-up (at least one year) and blinding of the outcome assessors.

There was a moderate amount of evidence for answering this question. The evidence from five trials indicates that there is no difference between CCBT and traditional CBT. However it should be noted hat most of these trials were small in size ranging from 36 to 69 participants, and the lack of statistically significant difference may be due to the size of the trial. The only large trial of 201 participants was an evaluation of prognostic factors, rather than a full report of the outcomes for each treatment group.

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