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Published Papers

  • DateTitle
  • 2004
    Cost effectiveness of Beating the Blues 

    McCrone, P., Knapp, M., Proudfoot, J., Ryden, C., Cavanagh, K., Shapiro, D., Ilson, S., Gray, J., Goldberg, D., Mann, A., Marks, I.M. & Everitt, B (2004) Cost-effectiveness of Computerised Cognitive Behavioural Therapy for Anxiety and Depression in Primary Care. British Journal of Psychiatry. 185, 55-62.


    McCrone et al. present an analysis of the cost effectiveness of offering Beating the Blues in general practice settings (N=274). In the context of the superior clinical outcomes of Beating the Blues, no significant differences were found in healthcare service costs betweentwo groups, indicating the computer treatment is a cost-effective intervention. Moreover, patients receiving Beating the Blues evidenced a significant costin terms of practitioner certificated’ absence from work. Further, cost-utility analysis revealed benefits at a highly competitive cost per Quality-Adjusted Life Year.

  • 2004
    RCT of Beating the Blues in Primary Care Services – Cohort I & II combined analysis 

    Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D., Goldberg, D., Mann, A., Tylee, A., Marks, I., & Gray, J. (2004). Clinical effectiveness of computerized cognitive behavioural therapy for anxiety and depression in primary care. British Journal of Psychiatry, 185, 46-54.


    Following randomisation of a further 107 participants (in addition to the 167 reported upon above: cohort I) from four additional general practice groups, analysis of the expanded sample confirmed the efficacy of Beating the Blues within sub-samples based on clinical, demographic and setting variables. The program’s efficacy was unaffected by concurrent drug treatment, duration of pre-existing illness, severity of existing illness or treatment setting.

    However, in relation to anxiety, significant benefits of using Beating the Blues were found only for patients with more severe illness at outset (those scoring 18 or more on the Beck Anxiety Inventory on entry to the study). Of 128 patients commencing Beating the Blues in the combined sample, 89 (70%) completed all eight sessions of the program and the post-treatment outcome measures, suggesting that patients are as likely to persist with computerized as traditional treatment approaches. On completing the program, patients reported significantly higher treatment satisfaction than those receiving a comparative 8 weeks of usual care.


  • 2003
    Development and initial testing of Beating the Blues 

    Proudfoot, J., Swain, S., Widmer, S., Watkins, E., Goldberg, D., Marks, I., Mann, A. &.Gray, J.A. (2003b). The development and beta-test of a computer-therapy program for anxiety and depression: hurdles and preliminary outcomes. Computers in Human Behavior, 19, 277-289.


    This paper describes the development and beta-test of an eight-session computer therapy program for anxiety and depression, ‘Beating the Blues’. Developed by a multi-functional team, the program uniquely combines multi-media interactive computer technology with empirically-validated cognitive-behavioral therapy (CBT) techniques and crucial non-specific aspects of therapy.

    The paper describes how the project proceeded through its development phase, the unexpected hurdles that occurred and the lessons learnt. As an integral part of the development, the program was beta-tested with 20 patients. Despite the small numbers and the fact that the eight sessions were completed at an accelerated rate, feedback was positive. Patients reported it was helpful, easy to use, and of those who had had previous treatment for their problems, the majority indicated it compared at least as well as other forms of therapy. The beta-test also highlighted where changes were needed to the program. These were implemented prior to release of the program for the next phase of testing.

    Lastly, the beta-test indicated that the program had sufficient promise for it to be evaluated formally by randomized controlled trial.

  • 2003
    RCT of Beating the Blues in Primary Care Services: Cohort I 

    Proudfoot, J., Goldberg, D., Mann, A., Everitt, B., Marks, I. & Gray, J. (2003a). Computerized, interactive, multimedia cognitive behavioural therapy reduces anxiety and depression in general practice: a randomised controlled trial’, Psychological Medicine, 33, 217-227.


    Background. Cognitive-behavioural therapy (CBT) brings about significant clinical improvement in anxiety and depression, but therapists are in short supply. We report the first phase of a randomized controlled trial of an interactive multimedia program of cognitive-behavioural techniques, Beating the BluesTM (BtB), in the treatment of patients in general practice with anxiety, depression or mixed anxiety/depression.

    Method. One hundred and sixty-seven adults suffering from anxiety and/or depression and not receiving any form of psychological treatment or counselling were randomly allocated to receive, with or without medication, BtB or treatment as usual (TAU).

    Measures were taken on five occasions: prior to treatment, 2 months later, and at 1, 3 and 6 months follow-up using the Beck Depression Inventory, Beck Anxiety Inventory and Work and Social Adjustment Scale.

    Results. Patients who received BtB showed significantly greater improvement in depression and anxiety compared to TAU by the end of treatment (2 months) and to 6 months follow-up. Symptom reduction was paralleled by improvement in work and social adjustment. There were no interactions of BtB with concomitant pharmacotherapy or duration of illness, but evidence, on the Beck Anxiety Inventory only, of interaction with primary care practice. Importantly, there was no interaction between the effects of BtB and baseline severity of depression, from which we conclude that the effects of the computer program are independent of starting level of depression.

    Conclusions. These results demonstrate that computerized interactive multimedia cognitive behavioural techniques under minimal clinical supervision can bring about improvements in depression and anxiety, as well as in work and social adjustment, with and without pharmacotherapy and in patients with pre-treatment illness of durations greater or less than 6months. Thus, our results indicate that wider dissemination of cognitive-behavioural techniques is possible for patients suffering from anxiety and/or depression.


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