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Published online Apr This article has been cited by other articles in PMC. Abstract Background Depression is a major cause of disability worldwide, and computerised cognitive behavioural therapy CCBT is expected to be a more augmentative and efficient treatment.
According to previous meta-analyses of CCBT, there is a need for a meta-analytic revaluation of the short-term effectiveness of this therapy and for an evaluation of its long-term effects, functional improvement and dropout.
We included all RCTs with proper concealment and blinding of outcome assessment for the clinical effectiveness of CCBT in adults aged 18 and over with depression.
The main outcome measure and the relative risk of dropout were included in the meta-analysis. Results Fourteen trials met the inclusion criteria, and sixteen comparisons from these were used for the largest meta-analysis ever.
All research used appropriate random sequence generation and Intention-to-Treat analyses ITTand employed self-reported measures as the primary outcome. Also, there was no significant clinical effect at long follow-up and no improvement of function found.
Furthermore, a significantly higher drop-out rate was found for Accounting 206 bsu than for controls.
When including studies without BDI as a rating scale and with only modern imputation as sensitivity analysis, the pooled SMD remained significant despite the reduction from a moderate to a small effect.
Conclusion Despite a short-term reduction in depression at post-treatment, the effect at long follow-up and the function improvement were not significant, with significantly high drop-out. Considering the risk of bias, our meta-analysis implied that the clinical usefulness of current CCBT for adult depression may need to be re-considered downwards in terms of practical implementation and methodological validity.
It has also been recently emphasised that it is not a highly recoverable disorder, even when treated with established pharmacotherapy [ 2 ], challenging previously widely-held ideas on its treatability [ 3 ]. Therefore, there is a great amount of expectation placed on evidence-based cognitive-behavioural therapy CBT [ 4 ] as an alternative or addition to pharmacotherapy [ 56 ].
It is hypothesised that reconstructing distorted cognition or inadaptable behaviour with CBT is likely to lead to the reduction of symptoms [ 7 ]. Also, CBT seems to be beneficial as an early intervention or relapse prevention measure [ 12 ] and CBT is recommended by the National Institute for Health and Clinical Excellence NICE in preference over routine pharmacotherapy as a treatment for milder depression [ 13 ].
Nevertheless, making CBT widely used requires addressing inevitable resource allocation problems, including accessibility and cost-effectiveness [ 14 ].
There are now even greater expectations of CCBT, owing to its increased potential due to technological progress in terms of interactivity, multimedia functions and flexibility [ 16 ]. Also, to date, there have been five meta-analyses [ 18 - 22 ] which specifically looked at the effect of CCBT on adult depression, and all of them found that CCBT was of benefit with moderate effect sizes.
However, these systematic reviews cannot be considered to provide definitive and compelling support for CCBT due to both the lack of two significant perspectives from clinical implementation and the four issues of methodological validity. From the perspective of clinical implementation, one point is that they have never dealt with functionality.
In addition to functionality, on the other hand, it seems to be also insufficient that even long-term effectiveness has not been meta-analysed at all.
Considering methodological aspects, it seems that past meta-analyses have crucial limitations in quality. The first issue is the heterogeneity of both targeted disorders and intervention. In the former, three meta-analytic studies [ 181921 ] dealt with depression and other disorders such as anxiety disorders as common target disorders, implying a critical bias in the results due to considerable diagnostic heterogeneity, as CBT for depression and that for other disorders, such as anxiety disorders, are theoretically different interventions.Here is the best resource for homework help with ACCT Managerial Accounting at Boise State University.
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