Psychiatr Prax 2011; 38 - P56_TP
DOI: 10.1055/s-0031-1277921

Computer-aided Cognitive Behavioural Therapy for depression: a systematic review of the literature

C Sikorski 1, M Luppa 1, A Kersting 2, HH König 3, SG Riedel-Heller 1
  • 1Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Germany
  • 2Department of Psychosomatics and Psychotherapy, Leipzig University, Germany
  • 3Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Germany

Background/Objectives: Depressive disorders are highly prevalent in the general public. Structural deficits, long waiting lists for therapy, and the fear of stigmatization hinder affected individuals to seek adequate treatment. Computer-based approaches may help overcome these barriers. The aim of this study was to conduct a systematic literature search in order to assess the effectiveness of computer- and internet-based cognitive behavioural therapy (CCBT).

Methods: Medline, Cochrane Library, Web of Science and PsycINFO were searched for relevant articles. Only RCTs were included. Quality of studies was assessed and effect sizes were calculated.

Results: 16 studies were retrieved and included. In 8 studies, interventions were exclusively internet-based and did not include further therapist contact; six studies provided some kind of minimal therapist contact (e.g. monitoring of symptoms), while the remaining 2 studies compared full computer-based therapist contact to direct face-to-face therapy. Effect sizes depended on therapist time involvement and control group intervention (waiting list vs. active control group) and ranged between 0.0 and 1.1. Drop-out rates were highest for the studies with no therapist contact.

Discussion/Conclusions: CCBT provides an effective and potentially cost-effective interventional strategy for depressive disorders. Effects of no and minimal contact therapies are confounded with conditions of control groups and need further investigation. While patients with Major Depression seem to benefit from computer-based therapy with regular therapist contact, it remains unclear whether unattended self-help interventions over the internet are effective for this patient population. However, these interventions are effective in patients with mild to moderate depressive symptomatology. CCBT may serve as a first step of treatment within stepped care approaches and may help to offer treatment to individuals in remote areas and to decrease barriers to seek psychiatric care caused by stigma perception.

Funding: AOK Bundesverband.

Keywords: Treatment effectiveness, cognitive therapy, depression.