Online CBT is no more effective than usual GP care for depression
discover.dc.nihr.ac.uk
discover.dc.nihr.ac.uk
An interesting excerpt: "Take-up of computerised CBT was low, despite regular calls to encourage participants to use the programmes. The median number of sessions completed was two out of eight for Beating the Blues and one out of six for MoodGYM. Only 18% of people who started Beating the Blues completed all modules and 16% for MoodGYM."
Online CBT definitely is not effective if patients don't complete it despite receiving phone calls. I can imagine that getting the motivation to log in and do it is really difficult when you're already feeling hopeless-- even not-depressed people have enough trouble building and sticking to habits as it is.
But I still wonder if online CBT was effective for the small portion of participants who did complete it? What were the characteristics of those who did complete the app? Perhaps we can learn something.
CBT app builders should also consider that self-care options for depression have existed for a long time in the form of books. Can an app do a substantially better job than books? The idea of solving medical issues remotely has been tried for decades.
MoodGym and Beating the Blues have some evidence behind them. NICE was recommending Beating the blues because they have some evidence of efficacy for it.
Maybe there's a simple fix. Something like Flo to keep people engaged with it, or some kind of gamifaction.
Or maybe Recovery College combined with online CBT?
You know how 'traditional chinese medicine' came about? Mao needed to invent something to give to the peasants that wasn't expensive as real health care.
http://www.slate.com/articles/health_and_science/medical_exa...
Edit: Perhaps what you mean is that the Western notion of Chinese medicine as a viable alternative to Western medicine was invented by Mao? That might have some shred of truth. But it's a very narrowly defined truth, and a very semantic one.
It's more useful to think of memories as Michael Bay's version of "Pearl harbor".
People aren't going to use it if it sucks or isn't giving them value. I looked into Beating the Blues a while ago - it's not exactly a great experience. Being reminded just isn't enough.
> Can an app do a substantially better job than books?
I think so.
Books are passive content that you consume in your own time. And, it certainly is helpful. But an app can do so much more towards offering a much richer, more engaging experience. But - and this is crucial - you have to get it right. And I think it is MUCH easier to get a book right, than an app. A book is just the content - an app is a manifestation of that content; if the book could talk, what would it say? ask? how would it do it and how often?
We'll see. My side project is to scratch some CBT & behavioral itches I have had with an app. I could be entirely wrong, but I wont know till I finish and see if it is of use for me.
Hrm, I would not identify it as an appification of CBT - You can use it to help implement CBT or other behavioral/cognitive changes, but the actual understanding would need to be done previously, to get the most benefit. Although I suppose even without any previous knowledge or awareness, some value could be derived.
I have a scheduled time and place for meeting a doctor. Not going will inconvenience many people, so there's a lot of social pressure to go. I've already put it in my calendar, so mentally I've accepted that I'll be doing this for a couple hours. When I go, the next meeting will be scheduled, locking me into a virtuous cycle of commitment.
An online thing I can do on my own time? Ha! We've gotten pretty good at ignoring reminder emails, no set time was put into place, and there's no set rhythm.
The "right" way to test the effectiveness of the program is to still get people scheduled to go to a doctor's office, but instead of talking to a doctor, you use a computer (and schedule the next visit).
For people like me, the main advantage of college wasn't access to the professor's, it's the set timeframe, place, and penalties for not showing up. Same sort of thing applies here I think
there is good evidence that merely _reading_ the book "feeling good" by David burns (father of CBT) is as effective as medication.
this indicates the relationship matters, because we're talking about people who didn't _act_ on the book, but merely _read_ it.
Here's one relevant quote: "The effectiveness of stand-alone bibliotherapy was evaluated in five published studies by a team of investigators headed by Dr. Forrest Scogin from the University of Alabama. These researchers evaluated the effectiveness of Dr. David Burns' "Feeling Good" as well as Dr. Peter Lewinsohn's "Control Your Depression," as self-administered treatments for depression. The investigators concluded that Feeling Good was as effective as a full course of individual psychotherapy or as treatment with the best antidepressant drugs."
CBT - Cognitive Behavioral Therapy GP - General practitioner (normal doctor?)
I.e. I did notice that I can let thinking about some social interactions go where they would bother me in the past, but if I was depressed when I played with it, then maybe I would just notice how bad I was at benefiting from CBT at the moment where I should be letting something go.
1. Mindful meditation [free] -> Daily practice (30+ minutes)
John Kabat-Zinn [0] masters the link between science and meditation and has published very valuable books (including guided/audio meditation exercises) [1]. There are a couple of scientific studies which prove effectiveness [2] [3].
2. LSD [$5-10/dose + $25/multi-use test kit] -> One-time experience (every 6 months max.)
Benefits (mid- and long-term) are similar to those of meditation. It however requires one to literally read/understand/know everything about the substance before applying it (minimum literature: "The psychedelic explorer's guide" by Fadiman). Also, order a test kit and test before you ingest. Certain "edge cases"/people should not try it. In addition, you may be able to access your spiritual dimension, which increases quality of life even further (it is less immediate with meditation).
You may combine micro-dosing LSD with meditation for accessing the meditative state easier (it's quite a challenge for depressed people).
[0] https://en.wikipedia.org/wiki/Jon_Kabat-Zinn
[1] https://thepiratebay.org/torrent/4180277/Mindful_Way_Through...
[2] http://news.harvard.edu/gazette/story/2011/01/eight-weeks-to...
[3] http://www.vox.com/2015/8/27/9214697/meditation-brain-neuros...
https://www.theguardian.com/global/2017/jan/08/how-dropping-...
I would be interested to see a study of obvious alternatives - perhaps an online interactive exercise program, something that provided a positive social interaction, or how the use of a sleep tracker could affect depression.
This is a classic problem in drug trials as well: you get data on how the drug works in a controlled setting (when the patients are monitored) but in the real world: do people take their meds reliably?
It may be that many people suffering depression benefit from the (not specifically trained -- this is the point) GP talking to them as a forcing function. The diet companies know this well.
And it made no difference.
From the article: >> There was no significant difference between usual GP care, Beating the Blues plus usual care, or MoodGYM plus usual care at four, 12 or 24 months.
So I would say there was no indication that the online CBT was of any benefit whatsoever.
If so, then it seems like you could replace expensive (for the NHS, and therefore the taxpayer) one-to-one consultation sessions with visiting a website on your phone/tablet/whatever. It frees up doctor time for other patients, or just allows them to pursue other parallel avenues of treatment with the same patient. In fact it would probably also have the side benefit that, because there is none of the stigma or awkwardness associated with going to a doctor for mental health problems, more people are likely to try and get their problems sorted out.
Generally a win all round?
EDIT OK, I read the article after seeing the sibling comment, and the online CBT is in addition to the usual GPs treatment; sadly not the amazing win that I thought ;( I should trust the headline writers more, but unfortunately buzzfeed and their click-baity ilk have trained me to have a certain wariness and skepticism these days!
Hm, interesting phrasing.
Is this another way of saying "was found to be just as effective as the more expensive standard treatment"?
> There was no significant difference between usual GP care, Beating the Blues plus usual care, or MoodGYM plus usual care at four, 12 or 24 months.
No significant difference, so it's every bit as good.
> CBT delivered online or via a computer was thought to offer a potential low-cost alternative.
And it costs less.
So yes, they found it is less expensive and works just as well as the standard treatment, but choose to phrase it in a way to indicate the study had failed by saying "is no more effective" which misleadingly implies it might be less effective, rather than the more accurate "is just as effective", which is more clear and accurate given that there was "no significant difference".
> There was no significant difference between usual GP care, Beating the Blues plus usual care, or MoodGYM plus usual care at four, 12 or 24 months.
So if "usual GP care" is the baseline, online CBT doesn't add to that baseline.