JMIR Publications

ABSTRACT

Background:

Mental ill-health presents a major public health problem. A potential part-solution that is receiving increasing attention is computerized-delivered psychological therapy, particularly during the Covid-19 pandemic as healthcare systems moved to remote service delivery. However, computerized cognitive behavioural therapy (cCBT) requires active engagement by service users, and low adherence may minimise treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximise potential benefits.

Objective:

To produce a critical appraisal of published reviews about the acceptability of cCBT for adults.

Methods:

An umbrella review informed by the Joanna Brigg’s Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalised in terms of uptake, dropping-out from, or completion of, cCBT treatment; factors which facilitated or impeded adherence; and reports about user, carer and healthcare professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool; and undertaken independently by two reviewers.

Results:

The systematic searches of databases identified 234 titles; and nine reviews (covering 151 unique studies) met the criteria. Most studies comprised service users with depression, anxiety or, specifically, panic disorder/phobia. Operationalisation of acceptability varied across reviews thereby making it difficult to synthesise results. There was a similar number of guided and unguided cCBT programmes; 34% of guided and 36% of unguided users opted out; guidance included email-, telephone-, face-to-face- and discussion forum-support. The proportion who completed (i) guided cCBT - full programme, 8-74%; one module, 94%; some modules, 67-84%; and (ii) unguided cCBT - full programme, 16-66%; one module, 95%; some modules, 54-93%. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), Internet/ computerized delivery problems, negative perceptions about cCBT, low motivation, too busy/not having enough time and personal circumstances were stated as reasons for opting out. Yet, some users favoured the anonymous nature of cCBT, and the capacity to undertake cCBT in own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between socio-demographic variables, mental health status and cCBT adherence/opting-out. Users tended to be satisfied with cCBT, reported improvements in mental health and recommended cCBT. Overall, the results indicated that service users’ preferences were important considerations regarding the use of cCBT.

Conclusions:

The review indicated that ‘one size did not fit all’ regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake and adherence and, so, deliver treatment benefits and improve mental health.