Integrated therapist and online cognitive behavioural therapy for depression in primary care: the INTERACT research programme, including the INTERACT RCT

Background: Cognitive–behavioural therapy is an effective treatment for depression. A key question is how to increase access. Engagement with cognitive–behavioural therapy-based computerised interventions is poor, and programmes are inflexible and impersonal. Innovative use of technology and integration of online materials could increase engagement and widen access. Objectives: To develop and evaluate a novel approach to delivering cognitive–behavioural therapy for depression integrating therapist-led sessions and online cognitive–behavioural therapy materials. Design and methods: The INTEgrated theRApist and online CbT for depression research programme comprised four work packages. The first developed the online therapy platform and materials, and training for therapists. This comprised a series of studies: a systematic review and network meta-analysis to compare the effectiveness of different types and components of cognitive–behavioural therapy; a Delphi study focused on the effective components of cognitive–behavioural therapy; a decision model to evaluate the cost-effectiveness of different formats of delivering cognitive–behavioural therapy; a survey of accredited cognitive–behavioural therapy therapists asking about their use and views of different resources used in cognitive–behavioural therapy; and iterative design work aimed at understanding the design requirements for the platform. The prototype platform was then evaluated in a pilot study, with subsequent final refinement. The second and third work packages evaluated the clinical and cost-effectiveness of the intervention compared with usual general practitioner care in a multicentre randomised controlled trial (with a parallel economic evaluation) over 12 months in primary care patients with depression. The fourth examined the intervention's acceptability through a nested qualitative study of patients, therapists and supervisors. Conclusions: Integrated cognitive–behavioural therapy is an effective and acceptable treatment for patients with depression. There was uncertainty around the cost-effectiveness of the intervention. This novel mode of delivery could increase the availability of cognitive–behavioural therapy and access for those who find it difficult to attend appointments in person.