
Online CBT is no more effective than usual GP care for depression - DanBC
https://discover.dc.nihr.ac.uk/portal/article/4000366/online-cognitive-behavioural-therapy-is-no-more-effective-than-usual-gp-care-for-people-with-depression?utm_content=buffer3572b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
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df3
The study did not seem to separate the results of those who completed online
CBT from the majority who did not.

An interesting excerpt: "Take-up of computerised CBT was low, despite regular
calls to encourage participants to use the programmes. The median number of
sessions completed was two out of eight for Beating the Blues and one out of
six for MoodGYM. Only 18% of people who started Beating the Blues completed
all modules and 16% for MoodGYM."

Online CBT definitely is not effective if patients don't complete it despite
receiving phone calls. I can imagine that getting the motivation to log in and
do it is really difficult when you're already feeling hopeless-- even not-
depressed people have enough trouble building and sticking to habits as it is.

But I still wonder if online CBT was effective for the small portion of
participants who did complete it? What were the characteristics of those who
did complete the app? Perhaps we can learn something.

CBT app builders should also consider that self-care options for depression
have existed for a long time in the form of books. Can an app do a
substantially better job than books? The idea of solving medical issues
remotely has been tried for decades.

~~~
meesterdude
> despite regular calls to encourage participants to use the programmes

People aren't going to use it if it sucks or isn't giving them value. I looked
into Beating the Blues a while ago - it's not exactly a great experience.
Being reminded just isn't enough.

> Can an app do a substantially better job than books?

I think so.

Books are passive content that you consume in your own time. And, it certainly
is helpful. But an app can do so much more towards offering a much richer,
more engaging experience. But - and this is crucial - you have to get it
right. And I think it is MUCH easier to get a book right, than an app. A book
is just the content - an app is a manifestation of that content; if the book
could talk, what would it say? ask? how would it do it and how often?

We'll see. My side project is to scratch some CBT & behavioral itches I have
had with an app. I could be entirely wrong, but I wont know till I finish and
see if it is of use for me.

~~~
mercer
Hey, any chance you'd be open to telling me a bit about what you're working
on? I'm on a bit of a... journey to get beyond the 'shitty contract webdev
work', and the direction I'm looking to go is technology applied to psychology
(therapy and/or lifestyle, in particular). My first thought was also some CBT-
related app.

~~~
meesterdude
Sure. Well, It's an app to help you be a better person of your own design. CBT
is one of the libraries to choose from, but there are others for leadership,
relationships, health and so forth.

Hrm, I would not identify it as an appification of CBT - You can use it to
help implement CBT or other behavioral/cognitive changes, but the actual
understanding would need to be done previously, to get the most benefit.
Although I suppose even without any previous knowledge or awareness, some
value could be derived.

------
0xcde4c3db
As I recall, some influential people in NICE and/or the NHS _really_ wanted
this to work because it's vastly cheaper and more available than in-person
CBT. This result is consistent with a longstanding but controversial
hypothesis that the overall quality of the therapist-client relationship is
far more important than the nuts and bolts of whatever theory the therapist
follows [1].

[1]
[https://en.wikipedia.org/wiki/Dodo_bird_verdict](https://en.wikipedia.org/wiki/Dodo_bird_verdict)

~~~
charlieflowers
I recall something that supports this hypothesis.

there is good evidence that merely _reading_ the book "feeling good" by David
burns (father of CBT) is as effective as medication.

this indicates the relationship matters, because we're talking about people
who didn't _act_ on the book, but merely _read_ it.

~~~
garyrob
A link for that would be appreciated.

~~~
charlieflowers
Well, this may not have the supporting info you want, but it might help you
track it down:
[http://holisticonline.com/Remedies/Depression/dep_bibliother...](http://holisticonline.com/Remedies/Depression/dep_bibliotherapy.htm)

Here's one relevant quote: "The effectiveness of stand-alone bibliotherapy was
evaluated in five published studies by a team of investigators headed by Dr.
Forrest Scogin from the University of Alabama. These researchers evaluated the
effectiveness of Dr. David Burns' "Feeling Good" as well as Dr. Peter
Lewinsohn's "Control Your Depression," as self-administered treatments for
depression. The investigators concluded that Feeling Good was as effective as
a full course of individual psychotherapy or as treatment with the best
antidepressant drugs."

------
droithomme
"is no more effective than usual"

Hm, interesting phrasing.

Is this another way of saying "was found to be just as effective as the more
expensive standard treatment"?

> There was no significant difference between usual GP care, Beating the Blues
> plus usual care, or MoodGYM plus usual care at four, 12 or 24 months.

No significant difference, so it's every bit as good.

> CBT delivered online or via a computer was thought to offer a potential low-
> cost alternative.

And it costs less.

So yes, they found it is less expensive and works just as well as the standard
treatment, but choose to phrase it in a way to indicate the study had failed
by saying "is no more effective" which misleadingly implies it might be less
effective, rather than the more accurate "is just as effective", which is more
clear and accurate given that there was "no significant difference".

~~~
michaelchisari
I think you're misreading the results.

> There was no significant difference between usual GP care, Beating the Blues
> _plus usual care_ , or MoodGYM _plus usual care_ at four, 12 or 24 months.

So if "usual GP care" is the baseline, online CBT doesn't add to that
baseline.

------
gleenn
For those of us who don't know:

CBT - Cognitive Behavioral Therapy GP - General practitioner (normal doctor?)

~~~
EvilTerran
Yeah, "general practitioner" in the UK = "primary care physician" or "family
doctor" in other countries, more-or-less.

------
languagewars
I played with a free online cbt and got much further than their average
participant in this study.. I'm not sure if there is any use to cbt for
depression, but I would suspect that it would work better in a preventative
fashion.

I.e. I did notice that I can let thinking about some social interactions go
where they would bother me in the past, but if I was depressed when I played
with it, then maybe I would just notice how bad I was at benefiting from CBT
at the moment where I should be letting something go.

------
DanBC
Submitting this because some people on HN have said they're building apps to
help mental health treatment.

------
benevol
I can recommend:

1\. Mindful meditation [free] -> Daily practice (30+ minutes)

John Kabat-Zinn [0] masters the link between science and meditation and has
published very valuable books (including guided/audio meditation exercises)
[1]. There are a couple of scientific studies which prove effectiveness [2]
[3].

2\. LSD [$5-10/dose + $25/multi-use test kit] -> One-time experience (every 6
months max.)

Benefits (mid- and long-term) are similar to those of meditation. It however
requires one to literally read/understand/know everything about the substance
before applying it (minimum literature: "The psychedelic explorer's guide" by
Fadiman). Also, order a test kit and test before you ingest. Certain "edge
cases"/people should not try it. In addition, you may be able to access your
spiritual dimension, which increases quality of life even further (it is less
immediate with meditation).

You may combine micro-dosing LSD with meditation for accessing the meditative
state easier (it's quite a challenge for depressed people).

[0] [https://en.wikipedia.org/wiki/Jon_Kabat-
Zinn](https://en.wikipedia.org/wiki/Jon_Kabat-Zinn)

[1]
[https://thepiratebay.org/torrent/4180277/Mindful_Way_Through...](https://thepiratebay.org/torrent/4180277/Mindful_Way_Through_Depression_-
_Guided_Meditation_Practices)

[2] [http://news.harvard.edu/gazette/story/2011/01/eight-weeks-
to...](http://news.harvard.edu/gazette/story/2011/01/eight-weeks-to-a-better-
brain)

[3] [http://www.vox.com/2015/8/27/9214697/meditation-brain-
neuros...](http://www.vox.com/2015/8/27/9214697/meditation-brain-neuroscience)

~~~
DanBC
_How dropping acid saved my life_

[https://www.theguardian.com/global/2017/jan/08/how-
dropping-...](https://www.theguardian.com/global/2017/jan/08/how-dropping-
acid-saved-my-life-ayelet-waldman-books-depression?CMP=Share_iOSApp_Other)

------
chx
The original title is "Online cognitive behavioural therapy is no more
effective than usual GP care for people with depression" which by no means is
the same as the title here because CBT, ahem, has other meanings. Sorry.

------
Steeeve
If the GP care was ineffective, of course the CBT modeled after that care was
equally ineffective. To expect any different is just silly.

I would be interested to see a study of obvious alternatives - perhaps an
online interactive exercise program, something that provided a positive social
interaction, or how the use of a sleep tracker could affect depression.

------
gumby
to echo df3's point: this study showed that online CBT wasn't that helpful but
didn't couldn't tell if it was a compliance issue or a modality issue.

This is a classic problem in drug trials as well: you get data on how the drug
works in a controlled setting (when the patients are monitored) but in the
real world: do people take their meds reliably?

It may be that many people suffering depression benefit from the (not
specifically trained -- this is the point) GP talking to them as a forcing
function. The diet companies know this well.

------
tshtf
Couldn't the headline read: "Online CBT as effective as usual GP care for
depression"?

~~~
rrmm
The online stuff was in addition to GP care, not in lieu of it.

~~~
phkahler
>>The online stuff was in addition to GP care, not in lieu of it.

And it made no difference.

From the article: >> There was no significant difference between usual GP
care, Beating the Blues plus usual care, or MoodGYM plus usual care at four,
12 or 24 months.

So I would say there was no indication that the online CBT was of any benefit
whatsoever.

~~~
TeMPOraL
Or that both hit the ceiling on CBT effectiveness.

~~~
phkahler
There was no indication of that either.

------
walrus01
If one is familiar with acronyms used in BDSM it is really hard to read CBT
and interpret it as its non obscene version...

