Abstract
Background Computer-delivered psychological treatments have great potential, particularly for individuals who cannot access traditional approaches. Little is known about the acceptability of computer-delivered treatment, especially among those with comorbid mental health and substance use problems.ObjectiveThe objective of our study was to assess the acceptability of a clinician-assisted computer-based (CAC) psychological treatment (delivered on DVD in a clinic-setting) for comorbid depression and alcohol or cannabis use problems relative to a therapist-delivered equivalent and a brief intervention control.MethodsWe compared treatment acceptability, in terms of treatment dropout/participation and therapeutic alliance, of therapist-delivered versus CAC psychological treatment. We randomly assigned 97 participants with current depression and problematic alcohol/cannabis use to three conditions: brief intervention (BI, one individual session delivered face to face), therapist-delivered (one initial face-to-face session plus 9 individual sessions delivered by a therapist), and CAC interventions (one initial face-to-face session plus 9 individual CAC sessions). Randomization occurred following baseline and provision of the initial session, and therapeutic alliance ratings were obtained from participants following completion of the initial session, and at sessions 5 and 10 among the therapist-delivered and CAC conditions.Results Treatment retention and attendance rates were equal between therapist-delivered and CAC conditions, with 51% (34/67) completing all 10 treatment sessions. No significant differences existed between participants in therapist-delivered and CAC conditions at any point in therapy on the majority of therapeutic alliance subscales. However, relative to therapist-delivered treatment, the subscale of Client Initiative was rated significantly higher among participants allocated to the BI (F2,54 = 4.86, P = .01) and CAC participants after session 5 (F1,29 = 9.24, P = .005), and this domain was related to better alcohol outcomes. Linear regression modeled therapeutic alliance over all sessions, with treatment allocation, retention, other demographic factors, and baseline symptoms exhibiting no predictive value.Conclusions Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and complexities in treatment planning. The extent to which a client feels that they are directing therapy (Client initiative) may be an important component of change in BI and CAC intervention, especially for hazardous alcohol use.Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12607000437460; http://www.anzctr.org.au/trial_view.aspx?ID=82228 (Archived by WebCite at http://www.webcitation.org/5ubuRsULu)
Highlights
Mental health problems are highly prevalent, the gap between need for effective treatment and treatment received is large, for counseling interventions [1]
Participants in a trial of clinician-assisted computer-based (CAC) versus therapist-delivered treatment were able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and http://www.jmir.org/2011/1/e11/
We recently reported the results of the first randomized controlled trial of clinician-assisted computer-based (CAC) psychological treatment for depression and alcohol/other drug (AOD) use comorbidity [16]
Summary
Mental health problems are highly prevalent, the gap between need for effective treatment and treatment received is large, for counseling interventions [1]. Comorbidity, or the co-occurrence of two or more disorders such as depression and alcohol abuse/dependence, is the rule rather than the exception in clinical practice [4,5] and compounds the difficulties in treatment access [6]. Comorbidity has largely been ignored in research and policy, especially depression and alcohol/other drug (AOD) use comorbidity, and treatment services do not generally provide well for people with multiple disorders [7]. Improving access to effective treatments for high-prevalence, treatable disorders such as depression and AOD use is an important health care priority. Little is known about the acceptability of computer-delivered treatment, especially among those with comorbid mental health and substance use problems
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