Eric Dedert, PhD
Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, N.C.
Washington (DC): Department of Veterans Affairs; October 2013
Download PDF: Complete Report, Executive Summary, Report, Appendices
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 Veteransï¿½ 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.
The key research questions for this systematic review were developed after a topic refinement process that included a preliminary review of published, peer-reviewed literature; consultation with internal partners and investigators; and consultation with content experts and key VA stakeholders. During the topic refinement process, the scope of this review was narrowed to focus on depressive and anxiety disorders, with plans to complete a subsequent review on alcohol and substance abuse disorders.
Key Question 1: For adults with depressive disorder, posttraumatic stress disorder, panic disorder, or generalized anxiety disorder, what are the effects of computerized CBT (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?
Systematic Review: Computerized Cognitive Behavioral Therapy for Adults with Depressive or Anxiety Disorders (Management eBrief)