A new online platform will let therapists deliver cognitive behavioural therapy (CBT) in real-time, blending face-to-face sessions with digital materials to treat depression in primary care. Depression is common, but high-intensity CBT—the most effective form—is scarce. Existing computerised CBT programmes are cheap but inflexible, and without therapist support their benefits are modest and short-lived. This project aims to close that gap by integrating a therapist’s guidance with online tools, allowing the clinician to adapt treatment to each patient while reducing the total time they spend per person. If the approach proves effective, it could expand access to high-quality CBT across the NHS, particularly for people who struggle to attend in-person appointments—those in remote areas, with inflexible work schedules, or with mobility issues. The research will test clinical and cost-effectiveness in a randomised trial of 434 patients across Bristol, London, and Hull/York, measuring depression scores, remission rates, and quality of life over 12 months. A nested qualitative study will capture what patients and therapists think of the blended format. If successful, the model could become a standard option in primary care mental health services.
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Aims and Objectives: The aim is to integrate online cognitive behavioural therapy (CBT) materials with input from an accredited CBT therapist in order to increase the availability of high intensity CBT for patients with depression in UK primary care. Objectives: To identify clinical and cost-effective components of CBT to inform the development of the intervention To develop: (1) an online platform to support the delivery of integrated CBT; (2) online CBT materials; and (3) an online training package for therapists To examine the clinical and cost-effectiveness of an integrated approach to delivering CBT for depression over 12 months To explore patients and therapists views and experiences of using this approach Background and rationale: There is a gap in the provision of high intensity CBT. Computerised CBT (cCBT) programmes are inexpensive but lack flexibility and, in the absence of therapist support, effects are modest and short-term. Real-time delivery of CBT online is acceptable and effective. Technological advancements make it possible to reduce therapist time and incorporate online materials and use of mobile devices as integral parts of therapy in a way that permits the therapist to adapt CBT to the patient s needs. This novel integration, which blends high intensity therapy with innovative use of technology to maintain the effectiveness of face-to-face CBT, needs to be evaluated in terms of clinical and cost-effectiveness, and acceptability. It will increase the general availability of CBT and include hard-to-reach groups and those for whom access is difficult. Research plan: Work-stream 1: Development of the IT platform and CBT content. Part 1: Identification of clinically effective components of CBT using multiple treatment meta-analysis. Part 2: Identification of cost-effective components of CBT using a decision analytic framework. Part 3: Development of the online platform by software engineers and experts in Human Computer Interaction. It will incorporate multiple channels of communication and support. There will be three iterations of design, development and user evaluation. Part 4: Development of CBT resources for the platform, and a training package for therapists. Work-stream 2: Multi-centre randomised controlled trial (RCT) of an integrated approach to delivering CBT for depression To establish the clinical effectiveness of an integrated approach to delivering CBT in reducing depressive symptoms and improving quality of life over 12 months (compared with usual care) for primary care patients with depression. Two parallel group multi-centre RCT with allocation at the level of the individual set in primary care in Bristol, London and Hull/York. Participants will be randomised to the intervention or usual care (including referral for supported cCBT). The integrated approach will be introduced in a face-to-face session, followed by 5-8 sessions online in real-time. Patients will work through online materials between sessions . The primary outcome will be score on the Beck Depression Inventory (BDI-II) at 6 months. Secondary outcomes will include response (at least 50% reduction of symptoms), remission (BDI-II score<10), anxiety and quality of life, and outcomes at 12 months. A sample size of 434 participants will give 90% power to detect a difference of 0.35 standard deviations on the BDI-II at two-sided alpha of 5%, assuming 20% attrition at 6 months. Work-stream 3 will evaluate the cost effectiveness from the perspectives of NHS and personal social services, patients and carers, and society. Work-stream 4: Qualitative study nested within the trial exploring patients and therapists views and experiences of the intervention (including the therapist-patient relationship, flexibility of session timing and between session work). Projected outputs and dissemination plans: We will publish in high impact peer review journals and target the main UK scientific audi
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