Behavioural and Cognitive Psychotherapy, the research journal of the BABCP, begins its current issue with a study of ‘computer-guided CBT’. What conclusions can be drawn?
The study concerns one commercial product, FearFighter.
FearFighter became well known when, together with another commercial product, Beating the Blues, it was recommended by NICE as an effective form of treatment on the basis of very flimsy evidence.
At the time, NICE had refused even to consider two other well-established computer-guided CBT programs that were (and still are) publicly funded and free for everyone to use online: Living Life to the Full, and MoodGym. So the commercial newcomers got loads of business through NICE, while the well-established free services were sidelined.
Well, things moved on, and Glasgow-based Living Life to the Full got recognition. It was hardly likely to stay sidelined, because it was developed by a former president of the BABCP. But by that time the commercial offerings already had contracts with many NHS trusts, so it didn’t matter much.
The newest development is the Department of Health’s Improving Access to Psychological Therapies (IAPT) programme, which will eventually provide many more CBT therapists throughout England and Wales. That’s going to mean competition for these commercial computer packages, and it’s not clear how they’ll respond.
But Scotland is different. IAPT doesn’t apply there, and they have their own programme based on…wait for it…the Glasgow-based Living Life to the Full.
Now this research study is published that looks at how the commercial package, FearFighter, works in rural Scotland, Living Life to the Full’s back yard. It’s a direct challenge to the Scottish programme.
The study has a special section of the journal all to itself, entitled: Empirically Grounded Clinical Interventions
The abstract is all many people ever read, and the only part that’s publicly accessible. Do you think it’s going to say anything negative about the product?
Results: Clients reported moderate to high levels of improvement and of overall satisfaction…
Conclusions: It is concluded that computer-guided CBT is acceptable to clients and to professionals, and that it could play a valuable part…
But turn the page (if you have access) and you see that 20 of the 29 patients reported the product met either none or only a few of their needs. 24 out of 29 said it didn’t really help or only helped them somewhat to deal more effectively with their problems.
What kind of empirical grounding is this? We’re supposed to have peer review to protect us from commercial manipulation of published research, but instead we end up with an advertorial as the leading article in what purports to be a research journal.