SELF-ADMINISTERED PSYCHOTHERAPY FOR DEPRESSION USING A TELEPHONE-ACCESSED COMPUTER-SYSTEM PLUS BOOKLETS - AN OPEN US-UK STUDY

Objective: To evaluate the efficacy and acceptability of a self-help p rogram for mild-to-moderate depression that combined treatment booklet s and telephone calls to a computer-aided Interactive Voice Response ( IVR) system. Method: In an open trial, 41 patients from Boston, Massac husetts; Madison, Wisconsin; and London, England, used COPE, a 12-week self-help system for depression. COPE consisted of an introductory vi deotape and 9 booklets accompanied by 11 telephone calls to an IVR sys tem that made self-help recommendations to patients based on informati on they entered. Results: All 41 patients successfully completed the s elf-assessment in the booklets and telephone calls; 28 (68%) also comp leted the 12-week self-help program. Hamilton Rating Scale for Depress ion (HAM-D) and Work and Social Adjustment scores improved significant ly (41% and 42% mean reduction in the intent-to-treat sample, respecti vely, p < .001). Eighteen (64%) of the 28 completers were considered r esponders on the basis of greater than or equal to 50% reduction in th eir HAM-D scores. There was a higher percentage of completers in the p ooled U.S. sites (82% vs. 43%), and U.S, completers improved more than those in the United Kingdom (73% vs. 43% were responders). Most (68%) of the calls were made outside usual office hours, Monday-Friday, 9:0 0 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls (more treatment modules) correlated positively with improv ement over 12 weeks. Mean call length for completers was 14 minutes. C onclusion: A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with m ild-to-moderate depression. These preliminary results are encouraging for people who cannot otherwise access ongoing, in-person therapy.