Systematic Review: Computerized Cognitive Behavioral Therapy for Adults with Depressive or Anxiety Disorders
Given the high rates of mental illness among Veterans returning from Iraq and Afghanistan, it is not surprising that the demand for VA mental health services has increased 132% since 2006. Cognitive behavioral therapy (CBT) is effective in treating mild to severe mental health symptoms. Computer-based programs grounded in CBT (computerized CBT [cCBT]) have generally been shown to produce significant reductions in depressive and anxiety symptoms, but treatment effects vary across studies. The availability of support via e-mail, instant messaging, or phone contact with a therapist may mitigate attrition and improve treatment outcomes. However, the extent to which support-related factors influence treatment response to cCBT programs is unclear. To support the development of cCBT programs, VA commissioned HSR&D's Evidence-based Synthesis Program (ESP) to conduct a systematic review of the literature. Investigators with the ESP in Durham, NC reviewed the literature from January 1990 through August 2013 and found 47 relevant randomized controlled trials (RCTs); the majority of trials were conducted outside the United States, and only one involved U.S. military personnel or Veterans. Investigators found moderate to strong evidence that cCBT – when compared with control conditions – is effective in improving end of treatment symptoms for mid-life patients (median age 39.8, range 20 to 58) with mild to moderate major depressive disorder, generalized anxiety disorder, or panic disorder. Treatment effects were smaller in studies of patients who were enrolled based on a positive depression symptom screen compared with studies of patients enrolled using a formal diagnostic assessment of depression. For PTSD and participants enrolled based on a positive anxiety symptoms screen, the evidence was insufficient to draw a conclusion. Investigators also found evidence suggesting that a greater level of therapist support was related to greater benefit, but additional head-to-head trials examining varying levels of therapist support are needed to address this issue definitively. It is suggested that VA/DoD consider this body of evidence when updating their clinical guidelines for depression and anxiety disorders.
