Excerpt

Given the high rates of mental illness among Veterans returning from Iraq and Afghanistan, it is not surprising that the demand for mental health services in Veterans Health Administration (VHA) has increased 132 percent since 2006. The most commonly diagnosed and treated disorders among Veterans receiving care at VHA include (1) PTSD, (2) depressive disorders, (3) episodic mood disorders, (4) anxiety disorders, and (5) substance use disorders. Unfortunately, shortages in trained mental health providers and logistical barriers limit Veterans’ access to evidence-based therapies.

To address the growing need and barriers to accessing mental health services, the VA/Department of Defense (DoD) developed the Integrated Mental Health Strategy (IMHS), which includes the development of a series of Web-based self-help programs. Because web-based programs can be accessed anonymously, anytime, anywhere, and by multiple Veterans simultaneously, these services have the potential to surmount stigma and geographical and financial barriers to accessing mental health treatment.

Cognitive behavioral therapy (CBT), using group or individual face-to-face therapy, is effective in treating mild to severe mental health symptoms. Computer-based self-help 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 email, instant messaging, or phone contact with a therapist may mitigate attrition and improve treatment outcomes. Still, it is unclear how support-related factors influence treatment response to cCBT programs. To support the development of cCBT self-help programs, the VA commissioned the Evidence-based Synthesis Program to conduct a systematic review of the literature.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • SEARCH STRATEGY AND STUDY SELECTION
  • DATA SYNTHESIS
  • RISK OF BIAS (QUALITY) AND STRENGTH OF EVIDENCE ASSESSMENT
  • PEER REVIEW
  • RESULTS
  • CLINICAL AND POLICY IMPLICATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • COMPUTERIZED COGNITIVE BEHAVIORAL THERAPY
• METHODS
  • TOPIC DEVELOPMENT
  • ANALYTIC FRAMEWORK
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • RISK OF BIAS (QUALITY) ASSESSMENT
  • DATA SYNTHESIS
  • STRENGTH OF THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE SEARCH
  • DESCRIPTION OF INCLUDED STUDIES
  • KEY QUESTION 1 For adults with depressive disorder, posttraumatic stress disorder, panic disorder, or generalized anxiety disorder, what are the effects of cCBT interventions compared with inactive controls?
  • KEY QUESTION 2 For cCBT interventions, what level, type, and modality of user support is provided (e.g., daily telephone calls, weekly email correspondence); who provides this support (e.g., therapist, graduate student, peer); what is the clinical context (primary intervention, adjunct); and how is this support related to patient outcomes?
  • KEY QUESTION 3 For adults with depressive disorder, posttraumatic stress disorder, panic disorder, or generalized anxiety disorder, what are the effects of cCBT interventions compared with face-to-face therapy?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • CLINICAL AND POLICY IMPLICATIONS
  • STRENGTHS AND LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSION
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B CRITERIA USED IN RISK OF BIAS ASSESSMENT
• APPENDIX C PEER REVIEW COMMENTS
• APPENDIX D STUDY CHARACTERISTICS TABLES
• APPENDIX E GLOSSARY

Research Associate: Avishek Nagi, MS; Medical Editor: Liz Wing, MA.

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, D.C. 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, N.C., John W. Williams Jr., M.D., M.H.Sc., Director.

Suggested citation:

Dedert E, McDuffie JR, Swinkels C, Shaw R, Fulton J, Allen KD, Datta S, Williams JW. Computerized Cognitive Behavioral Therapy for Adults With Depressive or Anxiety Disorders. VA-ESP Project #09-010; 2013.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.