Modest Clinician Support Enhances Computer-Assisted Cognitive Behavioral Therapy

Telephone or face-to-face support had a significantly larger effect in conjunction with computer-assisted cognitive behavioral therapy than online asynchronous support.

Computer-assisted cognitive behavioral therapy (CCBT) administered with modest support from a clinician or other support individual was effective in improving depressive symptoms in patients compared with self-guided CCBT, according to study data published in the Journal of Clinical Psychiatry.

Investigators conducted an online search of Ovid MEDLINE, PsycINFO, PubMed, and Scopus from inception to July 18, 2016 for randomized controlled trials of CCBT for depression. Study data were extracted independently by 2 reviewers and finalized for discussion by an additional investigator. Studies were selected for inclusion if validated assessments were used to capture depression symptoms and if posttreatment depression scores were reported. The difference in depression score means at posttreatment between study conditions was used to calculate effect sizes.

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A total of 223 studies were identified, of which 40 were selected for inclusion. The overall mean effect size for CCBT compared with control conditions was g=0.502 (standard error [SE], 0.057; 95% CI, 0.390-0.614; P <.001), representing a moderate to large effect. However, significant heterogeneity was observed in effect sizes (P <.001). Studies that provided support from a clinician or other individual yielded significantly larger effects (g=0.673) compared with studies in which CCBT was self-guided (g=0.239). When support types were examined, in-person support was most effective (g=0.833), while effect sizes were lowest for e-mail support (g =0.562). Studies with lower completion rates reported lower mean effect sizes, as did studies conducted in primary care practices.

These data indicate that CCBT has a moderate to large antidepressant effect, although further research to enhance its implementation is necessary. Specifically, research should identify the type of support needed for effective delivery, methods to improve engagement, and ways to improve treatment outcomes in primary care settings.


Wright JH, Owen JJ, Richards D, et al. Computer-assisted cognitive-behavior therapy for depression: a systematic review and meta-analysis. J Clin Psychiatry. 2019;80(2):18r12188.