The effectiveness and acceptability of a computerised cognitive behavioural therapy programme and the psychometric properties of its service user generated outcome measure
Background: Physical and psychological ill-health is strongly interlinked. Poor physical health can amplify psychological symptoms; whilst disabling physical symptomology and illnesses have been improved by the treatment of depression and/or anxiety. Currently, demand outstrips the supply of psychological treatments for common mental health problems. This is mainly due to the lack of trained therapists in the UK. Effective and less herapist-intensive interventions are required. The efficacy of computerised cognitive behavioural therapy (CCBT) has been demonstrated in routine primary care. However, service users in secondary care and those with physical and psychological co-morbidities have frequently been excluded from these studies. Further research, particularly qualitative research, focusing on service users' satisfaction with CCBT has also been called for by National Institute for Health and Clinical Excellence (NICE) reviewers. Concurrently,v ery little knowledge exists on what problems users bring to work on in CCBT sessions; whilst service user empowerment perspectives call for an increase in supported self help interventions and "patient as expert" quality of life outcome measures in order to improve accessibility to services and actively involve service users in the delivery of their care. Aims: The first reported piece of research was a naturalistic non-randomised study carried out to establish the effectiveness and acceptability of a CCBT programme, Beating the Blues, as an intervention for anxiety and depression in an NHS CBT specialist centre. The study also sought to identify whether physical co-morbidities altered the nature of the intervention's impact on clinical outcomes. The following two studies evaluated the psychometric properties of an electronic service user generated Subjective Units of Distress (SUDS) measure. Methods: Five hundred and ninety service users were included in the study. Three groups, a control group, a standard intervention group, and a physical co-morbidity intervention group, were compared on pre- and post-BDI-11 scores. The two intervention groups were also compared on pre- and post-BAI scores. Qualitative feedback and satisfaction rating scores were analysed to establish the acceptability of Beating the Blues. Despina Learmonth DPsych. (Health Psychology) 2007 The validity of the SUDS measurew as assessedu sing the BDI-11B, AI, and CORE-OMa validated measures with which the SUDS could be correlated. The internal reliability and sensitivity of the SUDS measure were also evaluated. A conventional content analysis was carried out to explore what types of problems service users chose to work on when using Beating the Blues. Results: In completer and intention-to-treat analyses, statistically significant differences were found for mean score changes on the BDI-11 between the control group and both the intervention groups. No differences were found between the intervention groups on either the BDI-I I or BAL A quarter and one fifth of completers in each group achieved reliable and clinically significant change on the BDI-11 and BAI respectively. In terms of acceptability, most of the participants found Beating the Blues to be a useful therapeutic tool. The qualitative feedback indicated four active core categories regarding both the features of Beating the Blues that service users found useful, and the ways in which they felt the programme could be improved upon. Seven main categories emerged from a number of sub-categories focusing on the described problems that service users choose to work on when using Beating the Blues. Service users broadly described symptoms, and emotional and practical issues as problems. The SUDS appeared to be sensitive to clinical change and to provide some measure of wellbeing, problems, and functioning; however, further research into certain aspects of its validity is still required. Conclusion: The research findings provided compelling evidence that Beating the Blues may be of value to service users suffering with depression and/or anxiety and varied physical and psychological co-morbidities in secondary care CBT specialist centres. The electronic SUDS measure contained within the programme also demonstrated potential to successfully incorporate service users' perspectives into more comprehensive evaluations of their wellbeing and quality of life. Further research needs to focus on: factors affecting adherence to Beating the Blues and its effectiveness with anxiety, the incorporation of physical health outcome measures, the use of the programme - including the SUDS measure - with individuals from different ethnic and socio-economic backgrounds, acceptability of the SUDS measure to practitioners, and reasons for its non-completion amongst service users.