On 2015 Dec 09, Hilda Bastian commented:

This is an excellent trial on an important subject, but the authors go beyond what the data in this study can support here: "The overall conclusion is that supported computerised cognitive behaviour therapy confers modest or no benefit over usual GP care..."

As others have pointed out in rapid responses at the BMJ, this study primarily shows that particularly low adherence to online CBT had little, if any, impact. The study was powered only to detect a difference at the effect sizes for supported computer-based/online CBT, while the type of support provided in this trial was minimal (and not clinician or content-related). The participants were more severely depressed than the groups for whom online CBT was offered in other trials (and in recommendations for its use), other care in each arm often included antidepressants, and the extent of use of CBT (online or otherwise) in the GP group is not known. The results are very relevant to policy on offering online CBT. But I don't think there is enough certainty from this one trial to support a blanket statement about the efficacy of the intervention rather the potential impact of a policy of offering it.

The size of this study, while large, is smaller than the other studies combined, and without a systematic review it is not clear that this study would shift the current weight of evidence. An important difference between this trial and studies in this field generally is that personal access to the internet was not required. I couldn't locate any data on this in the report. It would be helpful if the authors could provide information here on the level of personal, private access to the internet people had in each arm of the trial, so that it's possible to take this potential confounder into account in interpreting the results.

Free online CBT is also an option for those who cannot (or will not) get in-person therapeutic care. Many people with mild or moderate depression do not get professional care for it, and it doesn't seem reasonable on the basis of this to discourage people from trying free online CBT out. Yet, the press release for this study was headlined, "Computer assisted cognitive behavioural therapy provides little or no benefits for depression" (PDF), setting off media reports with that message. That far exceeds what the data from this one trial can support.

Disclosure: I have not been involved in the development of any online, or in-person, therapy for depression. I was co-author of a 2003 systematic review on the impact of the internet, which concluded that CBT-based websites for mental health issues at that time had mixed results (PDF), and I have since written favorably about online CBT.

On 2015 Dec 09, Hilda Bastian commented:

This is an excellent trial on an important subject, but the authors go beyond what the data in this study can support here: "The overall conclusion is that supported computerised cognitive behaviour therapy confers modest or no benefit over usual GP care..."

As others have pointed out in rapid responses at the BMJ, this study primarily shows that particularly low adherence to online CBT had little, if any, impact. The study was powered only to detect a difference at the effect sizes for supported computer-based/online CBT, while the type of support provided in this trial was minimal (and not clinician or content-related). The participants were more severely depressed than the groups for whom online CBT was offered in other trials (and in recommendations for its use), other care in each arm often included antidepressants, and the extent of use of CBT (online or otherwise) in the GP group is not known. The results are very relevant to policy on offering online CBT. But I don't think there is enough certainty from this one trial to support a blanket statement about the efficacy of the intervention rather the potential impact of a policy of offering it.

The size of this study, while large, is smaller than the other studies combined, and without a systematic review it is not clear that this study would shift the current weight of evidence. An important difference between this trial and studies in this field generally is that personal access to the internet was not required. I couldn't locate any data on this in the report. It would be helpful if the authors could provide information here on the level of personal, private access to the internet people had in each arm of the trial, so that it's possible to take this potential confounder into account in interpreting the results.

Free online CBT is also an option for those who cannot (or will not) get in-person therapeutic care. Many people with mild or moderate depression do not get professional care for it, and it doesn't seem reasonable on the basis of this to discourage people from trying free online CBT out. Yet, the press release for this study was headlined, "Computer assisted cognitive behavioural therapy provides little or no benefits for depression" (PDF), setting off media reports with that message. That far exceeds what the data from this one trial can support.

Disclosure: I have not been involved in the development of any online, or in-person, therapy for depression. I was co-author of a 2003 systematic review on the impact of the internet, which concluded that CBT-based websites for mental health issues at that time had mixed results (PDF), and I have since written favorably about online CBT.