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Published Papers

  • DateTitle
  • 2008
    New Zealand Demonstration of Beating the Blues 

    In 2008 a New Zealand demonstration of Beating the Blues® in the Primary Health Care setting was undertaken. The demonstration involved four Primary Health Organisations (PHOs) in Northland and was delivered by Opening Doors Limited, Whangarei.

    General Practitioners (GPs) and primary mental health practitioners in 4 areas of Northland, identified as having an interest in the use of computerised CBT were invited to be part of the demonstration. Patients were referred by both the participating GPs and primary mental health practitioners. Patients were identified by clinical assessment and the use of the Beating the Blues® suitability and exclusion criteria. A total of 100 patients participated in the Beating the Blues® programme.

    Delivery methods

    The delivery method for Beating the Blues® was identified through close liaison between Opening Doors and each PHO to meet the particular needs of the PHO and the communities they serve. Delivery methods varied from use in GP clinics, use supported by an administration worker, to delivery by representatives from the Māori population.

    Evaluation measures

    Evaluation included use of the CORE Outcome Measure (CORE-OM) to assess individual patient progress and the overall clinical efficacy of Beating the Blues® for the group. The CORE-OM was completed by patients as part of the programme before they began session 1 and after session 8. Developed by the CORE Systems Group (clinicians and researchers representing psychiatry, psychotherapy, counselling and psychology) the CORE-OM provides information on four separate areas of clinical importance:

    • Well-being –e.g. how patients feel about themselves
    • Problems – e.g. symptoms
    • Functioning – e.g. close relationships, social life and general functioning
    • Risk – e.g. an indicator of risk of harming self or others.

    Demographic information including ethnicity and culture identified was collected as part of the initial referral information. In addition, patients completed a brief questionnaire at the end of the programme to assess the acceptability of the programme and their satisfaction with the treatment overall.

    Outcome of the demonstration

    CORE-OM scores pre and post Beating the Blues® indicated clinical change and benefit from the treatment (see Figure 1).

    Figure 1

    Figure 1. CORE-OM scores pre and post treatment for Northland demonstration

    * The CORE-OM includes 34 questions within 4 Clinical Dimensions (Wellbeing, Problems, Functioning, Risk). Each Clinical Dimension has a maximum score of 4, with a higher score indicating a higher level of reported problems and higher levels of distress and conversely, a lower score indicating clinical improvement.

    Clinical and patient feedback reported a real need and benefit to delivering Beating the Blues® as a treatment choice within New Zealand PHO services. Patient questionnaire feedback indicated that a majority (62%) of patients were satisfied with this form of help and were also happy with the programme presentation and content.


    The findings of the Northland demonstration support the use of Beating the Blues® in the New Zealand primary care setting. The programme was well-received by clinicians and patients, and shown to be effective for individual patients with depression and/or anxiety in effecting clinical change.

  • 2008
    Beating the Blues in a Specialist CBT Centre 

    Learmonth,D., Trosh,J., Rai,S., Sewell,J., & Cavanagh,K. (2008) A Computer based treatment for Anxiety and Depression in a Secondary/Tertiary Care Specialist CBT Service. Counselling and Counselling Research, 8:2, 117-123


    This study documents 6 years of Beating the Blues in use in a specialist CBT centre. Over 600 patients have been through the program and 70% of those completing the program were fully discharged without any face to face therapy. The requirement for face to face in the group using Beating the Blues was cut to a quarter of that normally required.

  • 2008
    CCBT in a specialist CBT Centre 

    Learmonth, D., and Rai, S. ( 2008) Taking computerized CBT beyond primary care.. British Journal of Clinical Psychology 47,111-118


    Beating the Blues was delivered in an NHS specialist CBT care centre as part of routine care. In this setting the median period of problem duration was 5-10 years and 80% of patients indicated that they had taken prescribed medication prior to treatment at the centre. 68.3% of patients completed the program, and 48.3% of completers achieved both reliable and clinical change.

  • 2007
    Beating the Blues in Higher Education 

    Mitchell, N., & Dunn, K (2007) Pragmatic evaluation of the viability of CCBT self-help for depression in higher education. Counselling and Psychotherapy Research, 7(3): 144-150


    A significant reduction in Beck Depression scores were observed in students ( mean age 25.6 years) completing Beating the Blues in a Higher Education Counselling Service. The results suggest that CCBT may be an effective intervention for depressed students.

  • 2007
    Beating the Blues in service users with physical co-morbidities 

    Learmonth, D., & Rai, S. (2007) Establishing the effectiveness of computerised cognitive behavioural therapy for secondary/tertiary mental health care service users with and without physical co-morbidities. Health Psychology Update, Volume 16, Issue 3, 42-48


    This study presents pre and post Beck Depression scores of service users with physical co-morbidites such as IBS, headaches, and chronic fatigue syndrome. These results are compared with a wait-list control group and with a standard intervention group (physical co-morbidities absent). The control group showed no statistically significant change whilst the co-morbidity group and the standard intervention group both showed similar statistically significant change pre and post treatment.

    The study provides compelling evidence that Beating the Blues is of value to service users presenting with a wide variety of physical co-morbidities.

  • 2006
    Open-trial of Beating the Blues in Primary and Secondary Care: effectiveness 

    Cavanagh, K., Shapiro, D., Van den Berg, S., Swain, S., Barkham, M. & Proudfoot, J. (2006). The effectiveness of computerised cognitive-behavioural therapy in routine primary care. British Journal of Clinical Psychology, Volume 45, Number 4, 499-514


    This open study supports the results of the randomised controlled trials and indicates that the findings of the RCTS can be generalised to routine care environments. It also demonstrates, by benchmarking, that the outcomes achieved by Beating the Blues are similar to those delivered by face to face CBT

  • 2006
    Service Development in Primary Care 

    Hunt, S., Howells, E., Stapleton, B ( 2006) The Addition of a Computerised Cognitive Behavioural Therapy Program, to a Stepped Care, Primary Care Mental Health Service. The Journal of Primary Care Mental Health, Volume 9, Number 2, 34-38.


    The paper describes the integration of ‘Beating the Blues’ into a stepped care, primary care mental health service. For the 54 clients completing the program, ‘Beating the Blues’ was found to significantly reduce depression, raise general health and increase work and social adjustment. Client feedback was also very positive- the vast majority found the program enjoyable, easy and pleasant to access, and helpful in working towards overcoming their depression and anxiety.

  • 2004
    Computerised therapies for common mental health problems: review and meta-analysis 

    Cavanagh, K & Shapiro, DA (2004) Computer treatment for common mental health problems. Journal of Clinical Psychology, 60, 239-251.


    This paper presents a review of the development of computer treatment programs over 4 decades and reports a small meta-analytic study demonstrating large effect sizes in favour of computer treatments for anxiety and depression for pre-/post- treatment outcomes and usual care/waitlist comparators.
  • 2004
    Service Development in a Community Mental Health Team 

    S. Van Den Berg, D.A Shapiro, D. Bickerstaffe, & K. Cavanagh (2004) Computerized cognitive-behaviour therapy for anxiety and depression: a practical solution to the shortage of trained therapists. Journal of Psychiatric and Mental Health Nursing, Vol 11,Issue 5, p 508


    Computerized cognitive behaviour therapy (CCBT) programs have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programs. We present the experience of a community mental health team (CMHT) resource centre with one such program, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice.

  • 2004
    Service Development in Primary Care 

    Fox, E., Acton, T., Wilding, B. & Corcoran, S. (2004) Service development report: an assistant psychologist’s perspective on the use of computerised CBT in a GP practice in Barnet. Quality in Primary Care, 12, 161-165.


    Fox et al (2004) present their experience of implementing a Beating the Blues service within a primary care setting. The pilot service, which was managed locally by an assistant psychologist, received 62 referrals, in a ten month period, of whom 56 were suitable for the program. 39 of these patients attended an initial appointment with the service, and 27 of these completed all eight interactive sessions of Beating the Blues. The paper goes on to discuss the local and personal experience of the authors in implementing the program.


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