Abstract
BackgroundDepression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited.ObjectiveReview evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term.MethodSystematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted.Principal Findings22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial.ConclusionsComputerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610000030077
Highlights
Anxiety disorders and major depressive disorders are common, costly and debilitating [1,2]
Review evidence that computerized cognitive behavior therapy (CBT) for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term
We examined studies in which computerised CBT was compared with face to face CBT
Summary
Anxiety disorders and major depressive disorders are common, costly and debilitating [1,2]. Less than half the people with these disorders see a physician and only a quarter receive appropriate treatment [3]. Effective treatments for these disorders exist (i.e., selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT) [4,5]. The public health impact of these remedies is limited for a number of reasons These disorders often are unrecognized [3,6], the efficacy of SSRIs may be limited to very severe cases [7], CBT is not widely available, in part because of insufficient numbers of adequately trained clinicians [8], and patients do not or cannot adhere to the costs and demands of face-to-face CBT treatment. Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited
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