Six hundred people with depression will be randomly assigned to receive either usual GP care alone, usual GP care plus a commercial computerised CBT package, or usual GP care plus a free-to-use computerised CBT package, and followed for two years. This matters because most people with depression are treated by their GP, and many want a talking therapy like cognitive behavioural therapy (CBT). But NHS CBT is not always immediately available. Computerised CBT packages exist—some free, some paid for by the NHS—but no one knows which works best for NHS patients, or whether the extra cost of a commercial package is justified. If this trial succeeds, it will tell the NHS whether offering computerised CBT alongside GP care improves outcomes for patients, and whether the NHS should pay for a commercial package or use a free one. That could change how depression treatment is delivered across primary care, making evidence-based talking therapy more accessible without requiring more therapists. The trial also examines how acceptable patients and NHS staff find this form of treatment, which will guide how it should be rolled out in practice.
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Depression is a major health problem. The majority of people with depression receive care from their GP. However, lots of people experiencing depression would also like to receive a "talking treatment" (counselling or psychotherapy). Cognitive Behaviour Therapy (CBT) seems to be the most effective type of talking treatment for depression but is not always immediately available in the NHS. Recently, therapists have developed a form of CBT that can be delivered by computer, which might make it easier to access this form of treatment. We call this "computerised CBT". There are different computerised packages, some of which are freely available and others which have to be paid for by the NHS. At the moment we do not know which of these works best for NHS patients with depression. The purpose of this study is to compare two (one free-to-use and one commercial) CBT packages to see if there are any additional benefits of offering this treatment to the care that people already receive from their GP. We will also examine whether the commercial package is better than the free-to-use package and whether the extra cost is justified. To answer these questions, we will randomly allocate 600 participants to receive either usual GP care alone, usual GP care plus a commercial CBT package, or usual GP care plus a free-to-use package. We will compare how people fare and the costs of the different options. We will recruit participants via their GP Practice in four centres (York, Sheffield, Bristol and Manchester) and follow them up for two years. It is also unclear how acceptable this form of treatment is for people with depression. We will examine this issue, and how it should be delivered in the NHS, by discussions with NHS staff and the patients participating in the trial.
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