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
Systematic Review: Computerized Cognitive Behavioral Therapy for Adults with Depressive or Anxiety Disorders (Management eBrief)