Telephone-supported computerised cognitive–behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial

TLDR

Computerised CBT for depression can be efficient, yet engagement remains low in primary‑care trials. The study examined whether adding telephone support to cCBT improves outcomes. In a pragmatic RCT, 187 participants received telephone‑facilitated MoodGYM and 182 received minimally supported MoodGYM, with depression, anxiety, and somatic symptoms measured at 4 and 12 months. Telephone facilitation doubled engagement, lowered PHQ‑9 scores by 1.9 points at 4 months (not significant at 12 months), and also improved anxiety and somatic complaints, yielding a small‑to‑moderate benefit comparable to other low‑intensity interventions.

Abstract

Background Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials. Aims We tested the benefits of adding telephone support to cCBT. Method We compared telephone-facilitated cCBT (MoodGYM) ( n = 187) to minimally supported cCBT (MoodGYM) ( n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months. Results Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints. Conclusions Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.