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Evidence supports use of computerised CBT

Re-the article 'NHS review questions evidence for computerised cognitive behaviour therapy' (News, 14 September).

We find this article inaccurate and misleading regarding the evidence base supporting Beating the Blues, which is now being routinely used in over 300 sites in the NHS.

First, the analysis referred to by ScHARR is not new. It was specifically commissioned by NICE to inform their assessment of computerised CBT. Accordingly the analysis does not question but supports the NICE recommendation (February 2006) that only Beating the Blues, of all products considered, should be used for mild and moderate depression.

Second, the article chooses to highlight concerns about whether CCBT can help improve the provision of effective services in mental health. In fact, sites now using Beating the Blues in routine care can clearly demonstrate reductions in waiting lists as well as significant improvements in mental health.

The experience of Swindon PCT is typical (Hunt S et al The Journal of Primary Care Mental Health 2006;9(2):34-38).

In the Taw Hill practice Beating the Blues significantly reduced depression, raised general health and increased work and social adjustment.

The paper concludes that CCBT gives access to a supportive, therapeutic intervention for some people who previously had little. The service is now being extended to the whole of Wiltshire.

Specialist mental health services also see the benefit. The CBT department in Chelmsford routinely offers Beating the Blues to all patients with depression and anxiety who are suitable candidates for CBT. Provision of the programme allows immediate treatment to be offered rather than waiting 18 months for individual therapy. The majority of patients do not require any further intervention.

There is little doubt that implementation of Beating the Blues is currently resulting in significantly improved services in mental health.

From Professor Peter Littlejohns, Clinical and Public Health Director, NICE...

Your article on CCBT suggests there is new evidence that casts doubt on the recommendations made by NICE in February 2006. In fact, the research referred to was commissioned by NICE to help us develop our guidance. We were fully aware of its findings, and took them into account before making our recommendations.

Contrary to the impression given in your article, the ScHARR report's conclusions are favourable towards making Beating the Blues and FearFighter available on the NHS, as was our guidance.

From Dr Eva Kaltenthaler and Professor John Brazier, ScHARR, University of Sheffield...

We would like to express our concern over your article on CCBT.

The article refers to our forthcoming publication, a Health Technology Assessment monograph (volume 10, issue 33).

This monograph is not new evidence, it is the same evidence that NICE used to produce its guidance on CCBT.

At no point was the feasibility of the products questioned.

We stated that there was uncertainty over some of the variables such as take-up rates but that the clinical and cost-effectiveness of Beating the Blues and FearFighter were well within the acceptable range for use in the NHS.

Further evidence on key variables would of course be desirable as would be the case for most new technologies.

The conclusions of the monograph are favourable towards recommending that Beating the Blues and FearFighter be made available to the NHS.

From Nigel Brabbins, CEO, Ultrasis

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