Beating the Blues: Computerised Cognitive Behaviour Therapy for the treatment of depression and anxiety with older people
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Introduction With increasing longevity the population of the world is becoming older and there are growing numbers of people over the age of 65 years. This has implications for services providing psychological treatment to older people as there is likely to be an increasing demand for evidenced-based treatments such as Cognitive Behaviour Therapy (CBT) in the coming years. There are, however, relatively few clinical psychologists specialising in working with older people and therefore additional ways of dealing with the growing demands are essential. Computerised Cognitive Behaviour Therapy (CCBT) offers one potential option and NICE recommends Beating the Blues (BTB) as the most clinically and cost-effective package for treating depression. However, no study to date has explored the use of BTB with older people. Objective The objective of the study was to address this gap in the literature and had the following aims: 1) to explore the uptake rate of BTB with older people; 2) to explore the characteristics of older people opting to receive BTB; 3) to explore the drop-out rate from BTB with older people; and 4) to determine if BTB was effective in reducing symptoms of depression and anxiety in older people experiencing these difficulties. The findings were compared to previous research on BTB with younger adults. Methodology A between-groups, repeated measures design (with assessment time as the repeated measure) was used. Participants were given a free choice of receiving BTB plus treatment as usual (BTB+TAU) or treatment as usual alone (TAU). Treatment as usual was provided by clinicians from older people community mental health teams (e.g. psychiatric nurses) and the only constraint that was placed in this was that no face-to-face psychological therapy from an accredited therapist could be provided. The participants opting to receive BTB also completed eight sessions of BTB on a weekly basis. All participants completed a range of outcome measures prior to commencing treatment (pre), after eight weeks (post) and after a further 4 weeks (one month follow-up). Results & Discussion The results indicated that 56.9 per cent of the participants opted to receive BTB and they reported having significantly more experience and confidence using a computer than those who declined BTB. It was also found that 72.7 per cent of older people completed all eight sessions of BTB (27.3 per cent discontinuation rate). This was comparable to what has been found in previous studies of BTB with younger adults. A two (treatment group) x three (time) repeated measures ANOVA revealed that, in comparison to the TAU group, the BTB+TAU group showed statistically significant greater improvements on measures of depression and anxiety by the end of treatment. This was maintained at one month follow-up. Furthermore, in comparison to the TAU group the BTB had a higher percentage of participants who met criteria for clinically significant improvement by the end of treatment and at one-month follow-up. The results suggest that BTB is an acceptable and effective treatment for older people experiencing depression and anxiety and the implications of these findings are discussed.