Overview
Beating the Blues is a computer-based cognitive behavioral therapy (CBT) program for primary care patients with depression and/or anxiety.
Beating the Blues is 9-session web-based program that uses interactive multimedia technology to foster individual skills to reduce anxiety and depression symptoms. Each 50-minute session is customized for the user, and contains advice, interactive menus, and personalized feedback to motivate and engage patients. Video-vignettes of patients are included to provide realistic examples of symptom management and CBT techniques. Physicians are given progress reports after each session.
Link to commercial site here.
Delivery:
Web-based
Theoretical Approaches:
Cognitive Behavioral Therapy (CBT)
Target Outcome(s):
Depression
Anxiety
Emotional distress
Psychiatric symptom severity
Work and social adjustment
Ages:
Young Adults (18-30)
Adults (30+)
Genders:
Male
Female
Races/Ethnicities:
Northern European
Eastern European
Caribbean Black
African Black
Asian
Other
Multiracial
Setting:
Primary care
College health center
Geographic Location:
Urban
Suburban
Country:
United Kingdom
Language:
English
Evaluations
Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice.
Summary: In this randomized controlled trial, Beating the Blues (BtB) was compared to usual care for primary care patients with depression and/or anxiety. Patients screening positive for anxiety and depression (n=167) were randomly assigned to receive either the BtB program, or to receive treatment as usual from their primary care provider. Participants in the usual care group were either prescribed psychotropic medications, or referred to counseling or support groups. Participants in the BtB program had weekly BtB sessions in their primary care office, in addition to standard treatment. Depression, anxiety, and work and social adjustment were assessed pre-treatment, post-treatment, and at 1-, 3-, and 6-month follow-ups. Participants assigned to BtB had significantly greater decreases in depression and anxiety symptoms at all follow-up assessments related to usual care. Participants receiving BtB also had larger improvements in work and social adjustment at each follow-up. Findings were consistent regardless of whether participants were prescribed psychotropic medications.
Take Away: Compared to usual primary care treatment for patients with anxiety and/or depression, Beating the Blues is associated with larger reductions in depressive and anxiety symptoms.
Follow-Up Studies
Clinical efficacy of computerized cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial.
Summary: This study was a continuation of the Beating the Blues (BtB) randomized controlled trial described in the Proudfoot et al, 2003, in which severity of symptoms, negative attributions, and treatment satisfaction were examined. After continuing to enroll participants, a total of 274 primary care patients with depression and/or anxiety were randomized to BtB or to usual primary care treatment. Although both the BtB and usual care groups had significant reductions in depression and anxiety severity, participants in the BtB group had larger decreases throughout the follow-up period than those in usual care. Additionally, participants getting BtB had fewer negative attributions and were more satisfied with their treatment than those getting usual care.
Take Away: For primary care patients with depression and/or anxiety, Beating the Blues may decrease psychiatric symptom severity more than usual primary care treatment.
Cost-effectiveness of computerized cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial.
Summary: Using data collected in the Proudfoot et al 2003 and 2004 studies, the authors examined the cost-effectiveness of the Beating the Blues (BtB) program. Data on services used, lost workplace productivity, and days of depression and anxiety were obtained from the 274 study participants. The authors compared the costs and effectiveness of BtB with usual primary care treatment for depression. Participants in the BtB group had 28.4 fewer days of depression than participants in the usual care group throughout the 6-month follow-up period. Although participants receiving usual care utilized more health services, no significant differences in service costs were detected. The usual care group missed more work throughout the follow-up period. If a depression free day has at least modest value, results of this analysis show that Beating the Blues has a high probability of being more cost-effective than usual care.
Take Away: The study provided some indication that Beating the Blues may be cost-effective method of treating anxiety and depression in primary care settings. Further work is needed.
Computerized cognitive behavioural therapy at work: A randomized controlled trial in employees with recent stress-related absenteeism.
Grime PR. Occupational Medicine. 2004. 54(5): 353-359. PMID: 15289593.
Summary: In this randomized controlled trial, Beating the Blues (BtB) was evaluated with service employees with stress-related absenteeism. To be eligible, individuals had to meet criteria for depression, anxiety, or stress, and have missed at least 10 days of work during the past 6 months because of these symptoms. Forty-eight participants were randomly assigned to get either treatment as usual (TAU) plus BtB, or TAU only. TAU primarily consisted of medication and counseling. Depression, anxiety, and attributional style were measured pre-treatment, post-treatment, and at 1-, 3-, and 6-month post-treatment assessments. In the BtB group, 67% of participants completed the program. Participants that received BtB had significantly greater improvement in depression, anxiety, and negative attributional style at the post-treatment and 1-month follow-ups. By the 3- and 6-month follow-up assessments, depression, anxiety, and negative attributional style did not differ between the BtB and TAU groups.
Take Away: For public service employees with stress-related absenteeism, Beating the Blues is effective in reducing depression, anxiety, and negative attributional style immediately after treatment but improvements were not sustained.
The effectiveness of computerized cognitive behavioural therapy in routine care.
Summary: Beating the Blues (BtB) was implemented in 11 health care practices (8 primary care and 3 mental health centers) in a naturalistic open-trial study. Patients with depression and/or anxiety (n=219) were offered BtB and completed assessments about mental health symptoms at intake, post-treatment, and 6-months post-treatment. All patients completed the first BtB session, and 62% completed the entire program. From intake to the post-treatment assessment, patients had significant decreases in depressive and anxiety symptoms. Thirty-one percent of treatment completers had clinically significant changes in their depressive and/or anxiety symptoms. Few patients (18%) completed the 6-month post-treatment follow-up. For these participants, mental health severity continued to decrease and 54% had clinically significant improvements in their mental health symptoms.
Take Away: Beating the Blues is feasible and can be effective when incorporated into routine clinical practice. Program engagement may influence outcomes.
Pragmatic evaluation of the viability of CCBT self-help for depression in higher education.
Mitchell N, Dunn K. Counselling and Psychoatherapy Research. 2007.7(3): 144-150.
Summary: This study describes the results of a feasibility study of Beating the Blues (BtB) for college students with depression. College students (n=12) with current depression were offered BtB through their college counseling department. Psychiatric severity and treatment satisfaction information was collected before treatment and at a 3-month follow-up. The students completed an average of 7.25 BtB sessions; 83% completed the entire program. Students had statistically significant decreases in depression severity from intake to follow up. No significant decreases in anxiety were detected. Students were satisfied with the program overall, and felt that BtB was easy to use and increased their knowledge of depression. Students reported a need for more personalized information.
Take Away: Beating the Blues is a feasible and acceptable treatment for college students with depression. Increasing the personalization of the program may improve satisfaction for college students.
Taking computerized CBT beyond primary care.
Learmonth D, Rai S. British Journal of Psychology. 2008. 47(1): 111-118. PMID: 17939879.
Summary: The authors enrolled adults with depression and/or anxiety in this naturalistic, open-trial of Beating the Blues (BtB). Patients on the waiting list for specialty cognitive behavioral therapy (CBT) treatment with no current substance dependencies or suicidal ideation were eligible to try BtB. All patients (n=104) had access to BtB. Depression and anxiety were measured pre- and post-treatment. Approximate 68% of patients completed all eight BtB sessions. The authors found no significant differences in demographics or clinical characteristics between BtB completers and patients who dropped out of the program. Both completers and non-completers had significant improvements in several domains, including their psychiatric well-being, problem severity, life functioning, and risk to self. Forty-nine percent of completers had clinical significant improvement in their depression and anxiety. The authors used trials of face-to-face CBT programs as a benchmark. When compared to face-to-face CBT, the outcomes elicited from BtB are comparable.
Take Away: Beating the Blues and face-to-face CBT programs have similar effects on depression and anxiety in adults.
The role of computer-aided psychotherapy within an NHS CBT specialist service.
Summary: A naturalistic trial of Beating the Blues (BtB) was conducted in a British National Health Service (NHS) cognitive behavioral therapy (CBT) specialist service. Patients (n=829) waiting for anxiety and/or depression treatment were offered BtB. Because of a 12 to 18 month wait from referral to receipt of CBT treatment, BtB was adopted to provide users on the waitlist with more immediate access to treatment. Questionnaires on depressive and anxiety symptoms were given to all users at intake and 6-8 weeks after completing BtB. Of the 829 patients referred to BtB, 67% tried the program. Of patients who started BtB, 71% completed the program. Overall, depression and anxiety decreased significantly from intake to the post-treatment assessment. Using the entire intent-to-treat sample, 21% of participants had clinically significant changes in depression, while 19% had clinically significant changes in anxiety. Participants completing BtB were referred to fewer treatment services at the follow-up. The completers also required fewer face-to-face sessions than the non-completers when they were referred (3.5 versus 15).
Take Away: Beating the Blues is feasible and effective for patients with depression and/or anxiety when adopted into specialist CBT programs.
Comparative, clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety provided on a self-help basis.
Summary: This study compared the feasibility and effectiveness of three self-help tools for treating mild to moderate depression and anxiety. Patients (n=100) with depression and/or anxiety were referred to the study from their primary care providers. Patients were excluded if they were suicidal, had substance dependencies, or were currently receiving medication or therapy to treat anxiety or depression. Eligible participants were consecutively assigned to one of three self-help conditions: 1) the Beating the Blues (Btb) program, 2) the Livinglifetothefull program, or 3) Self-help workbooks. Livinglifetothefull was another web-based cognitive behavioral therapy (CBT) program designed to treat anxiety and depression. The self-help workbooks were also CBT-based. Psychiatric symptoms were assessed pre- and post-treatment. Fifty participants completed the programs or workbooks. All three conditions had comparable dropout rates. Younger age and shorter duration of mental health problems increased the likelihood of study dropout. Across all participants, depressive and anxiety symptoms improved significantly from pre- to post-treatment. Ninety-two percent of study participants had reported improved psychological symptoms. Change in depression and anxiety did not differ between the three treatment conditions.
Take Away: For patients with mild to moderate depression and/or anxiety, Beating the Blues and other self-help CBT programs are similarly effective.
Computerised cognitive behavioural therapy in an adult mental health service: A pilot study of outcomes and alliance.
Summary: Previous research had found a relationship between mental health outcomes and the therapeutic alliance. In this pilot study, the authors extended that research by examining the association between the therapeutic alliance and outcomes in a pilot study of Beating the Blues (BtB). Twenty-three adults with depression were recruited from a mental health treatment program. All participants had access to BtB and were given assessments on depression and therapeutic alliance at baseline, 4- and 8-week follow-ups. Sixteen were included in all analyses, as they completed BtB and all assessments. From baseline to post-treatment, depression decreased significantly. 56% of completers had clinically significant changes in depression. Participants rated their therapeutic alliance with the BtB program favorably. Therapeutic alliance was not associated with depression severity at the follow-ups.
Take Away: In this pilot study, participants rated their therapeutic alliance with Beating the Blues favorably, though this alliance with not associated with mental health outcomes.
The implementation of computerized cognitive behavioural therapies in a service user-led, third sector self-help clinic.
Summary: Beating the Blues was implemented in an organization that provided depression and anxiety treatment services in multiple community venues using a pragmatic, open-trial, pre- and post-test. Over sixteen months, 510 individuals were referred to Beating the Blues (BtB). After completing an intake assessment, 69% of referrals were deemed suitable for BtB. Those individuals met with a volunteer, who supported the user and guided them through the program. All users starting the program completed assessments weekly and post-treatment. Eighty-four percent of eligible individuals started the program, while 53% completed the entire BtB program. Age, gender, race/ethnicity, medications, and having a chronic physical health problem had no impact on the likelihood of program completion. Users with less severe depression and anxiety symptoms were more likely to complete BtB. At intake, 22% of users met criteria for either depression or anxiety, while 63% met criteria for both disorders. At the post-treatment assessment, only 16% of users met criteria for one disorder and only 31% met criteria for both disorders.
Take Away: Beating the Blues may be effective for treating anxiety and depression when implemented in a community treatment organization.
Computerised cognitive behavioural therapy for depression and anxiety with older people: A pilot study to examine patient acceptability and treatment outcome.
Summary: This study examined the acceptability and efficacy of Beating the Blues (BtB) for older adults with depression. Individuals were recruited from mental health programs specializing in the treatment of older adults. Individuals age 65 or older with depression were eligible, while individuals with current dementia, psychotic symptoms, or suicidal ideation were excluded. Participants (n=510) chose whether they wanted to receive treatment as usual (TAU), or TAU plus BtB. TAU consisted of psychiatric assessment, medications, social support, group therapy, and referrals to specialists. All participants completed assessments at baseline, 2- and 3- follow-ups. Computerized treatment appeared to be acceptable to older adults, as 66% elected to try BtB. Completion rates were similar for BtB (73%) and TAU (80%). Participants who selected BtB were younger, more educated, more confident and experienced with computers, and were more likely to have internet access at home. The BtB and TAU groups had comparable psychiatric symptom severity at baseline. At the 2- and 3-month follow-ups, participants in the BtB group had significantly larger reductions in depression and anxiety than the TAU participants.
Take Away: Beating the Blues is acceptable and feasible for older adults, and may be an effective treatment approach for this population.
Related Articles
Computer-assisted cognitive-behaviour therapy for depression. Eells TD, Barrett MS, Wright JH, Thase M. Psychotherapy. 2014. 51(2): 191-197. PMID: 24059735.
Computerised therapy for depression with clinician vs. assistant and brief vs. extended phone support: Study protocol for a randomized controlled trial. Gega L, Swift L, Barton G, Todd G, Reeve N, Bird K, Holland R, Howe A, Wilson J, Molle J. Trials. 2012. 13:151. PMCID: 3495903.
The acceptability of computer-aided cognitive behavioural therapy: A pragmatic study. Cavanagh K, Shapiro DA, Van Den Berg S, Swain S, Barkham M, Proudfoot J. Cognitive Behaviour Therapy. 2009. 38(4): 235-246. PMID: 19306147.
The addition of a computerized cognitive behavioural therapy program, to a stepped care, primary care mental health service.Hunt S, Howells E, Stapleton B. Journal of Primary Care Mental Health. 2006. 9(2): 34-38.
Computerised cognitive behavior therapy for depression and anxiety update: A systematic review and economic evaluation.Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, Parry G, Rooney G, Sutcliffe P. Health Technology Assessment. 2006. 10(33): 1-168. PMID: 16959169.
Computer treatment for common mental health problems. Cavanagh K, Shapiro DA. Journal of Clinical Psychology. 2004. 60(3): 239-251. PMID: 14981789.
Computerized cognitive-behaviour therapy for anxiety and depression: A practical solution to the shortage of training therapists. Van den Berg S, Shapiro DA, Bickerstaffe D, Cavanagh K. Journal of Psychiatric and Mental Health Nursing. 2004. 11(5): 508-513. PMID: 15450016.
Service development report: An assistant psychologist’s perspective on the use of computerized CBT in GP practice in Barnet. Fox E, Acton T, Wilding B, Corcoran S. Quality in Primary Care. 2004. 12: 161-165.
The development and beta-test of a computer-therapy program for anxiety and depression: Hurdles and preliminary outcomes.Proudfoot J, Swain S, Widmer S, Watkins E, Goldberg D, Marks I, Mann A, Gray JA. Computers in Human Behavior. 2003. 18: 277-289. doi: 10.1016/S0747-5632(02)00062-6
Beating the Blues: Computerised cognitive-behavioral therapy. Gray JA, Proudfoot J, Swain S. Journal of Primary Care Mental Health. 2000. 33(2): 217-227.