ABSTRACT
Depression is a major public health problem across the world. Antidepressants are the front line treatment, but many patients either do not respond to them, or do not like taking them. The main alternative is psychotherapy, and the modern ‘talking treatments’ such as cognitive behavioural therapy (CBT) have been shown to be as effective as drugs, and probably more so when it comes to relapse. But there is a problem, namely availability-there are simply nothing like enough skilled therapists to meet the demand, and little prospect at all of this situation changing. A number of alternative modes of delivery of CBT have been explored, in-
cluding interactive systems making use of the new computer technologies. The principles of CBT lend themselves reasonably well to computerisation, and, perhaps surprisingly, patients adapt well to this procedure, and do not seem to miss the physical presence of the therapist as much as one might expect. The data to be used in this chapter arise from a clinical trial of an interactive, multimedia program known as ‘Beat the Blues’ designed to deliver cognitive behavioural therapy to depressed patients via a computer terminal. Full details are given in Proudfoot et al. (2003), but in essence Beat the Blues is an interactive program using multimedia techniques, in particular video vignettes. The computer based intervention consists of nine sessions, followed by eight therapy sessions, each lasting about 50 minutes. Nurses are used to explain how the program works, but are instructed to spend no more than 5 minutes with each patient at the start of each session, and are there simply to assist with the technology. In a randomised controlled trial of the program, patients with depression recruited in primary care were randomised to either the Beating the Blues program, or to ‘Treatment as Usual’ (TAU). Patients randomised to Beat the Blues also received pharmacology and/or general practice (GP) support and practical/social help, offered as part of treatment as usual, with the exception of any face-to-face counselling or psychological intervention. Patients allocated to TAU received whatever treatment their GP prescribed. The latter included, besides any medication, discussion of problems with GP, provision of practical/social help, referral to a counsellor, referral to a prac-
community psychiatric nurse, counsellor), or further physical examination. A number of outcome measures were used in the trial, but here we concen-
trate on the Beck Depression Inventory II (BDI, Beck et al., 1996). Measurements on this variable were made on the following five occasions: • Prior to treatment, • Two months after treatment began and • At one, three and six months follow-up, i.e., at three, five and eight months after treatment.
