The acceptability and effectiveness of computerised cognitive-behavioural self-help for depression in primary care : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University

Abstract

Cognitive Behavioural Therapy (CBT) is an effective treatment for depression; however lack of available practitioners and lack of resources in secondary mental health settings, mean patients often don’t receive this treatment. Self-help approaches including computer-based self-help are one option to meet this unmet need. However there is little research examining the effectiveness of computer-based self-help in primary care, and no current research conducted in a New Zealand sample. ‘Overcoming Depression’, a six session computer-based Cognitive Behavioural Therapy (CBT) programme for depression has demonstrated effectiveness in significantly reducing symptoms of depression in a pilot study in a clinical psychology clinic (Whitfield, Hinshelwood, Pashely, Campsie & Williams, 2006). The current study investigated the acceptability and effectiveness of ‘Overcoming Depression’ in General Practice in New Zealand. The current study is divided into two parts. The first part of this research was a survey of patients in general practice which showed that computer-based self-help is acceptable and most patients would be willing to try this as a treatment for depression. The second part of the research involved a randomized controlled trial of ‘Overcoming Depression’ in general practice. In this study ‘Overcoming Depression’ was found to significantly reduce depression as measured by the Hospital Anxiety Depression Scale (HADS) and the Primary Health Questionnaire-9 (PHQ-9). However due to low statistical power no significant differences were found between the ‘Overcoming Depression’ and a waiting list control group. While all completers evaluated the programme positively, low up-take and high drop out rates suggest that there needs to be careful consideration of how best to integrate this type of treatment in to primary care settings.