Why do General Practitioners Recommend (or not Recommend) Computer-delivered Cognitive Behavioural Therapy (CCBT) for Depression?

Abstract

Aim: Depression is a major global health problem. A cost-effective and accessible way of treating depression is through the use of Computer-delivered Cognitive Behavioural Therapy (CCBT). However, CCBT is not used frequently. One possible factor is the frequency with which General Practitioners (GPs) refer their patients to CCBT. GPs act as gatekeepers to its use and have the capacity increase or decrease the use of CCBT. This research aimed to answer the question: “Why do GPs recommend (or not recommend) Computer-delivered Cognitive Behavioural Therapy (CCBT) for depression?” Method: A qualitative approach was used for this research. The study participants were 10 registered GPs in New Zealand who had practised in New Zealand for at least one year. The participants were recruited through referrals from professors working at the University of Auckland. Data was gathered through semi-structured interviews and analysed using the general inductive approach. Findings: GPs recommend CCBT for the following main reasons: accessibility; flexibility; privacy; it is free of charge; it can be used for patients with severe depression who are on the waiting list for a specialist; it can be used as a complement to face-to-face therapy; it is useful for patients who do not like face-to-face therapy and for adolescents, as adolescents are more technologically oriented. The main reasons GPs do not recommend CCBT are: GPs’ lack of knowledge about computerised therapies; safety issues; the fact that patients do not usually finish the CCBT programs; patients not having access to computers; the patient’s depression is too severe; and it is not suitable for elderly patients. The majority of the GPs interviewed had already used CCBT for their patients with depression and said they would continue to use CCBT in the future. Conclusion: CCBT is an effective therapeutic method for depression and has many advantages over face-to-face therapy. Based on the findings of this study, medical doctors are probably not the cause of the low use of CCBT. More studies, using a cross-sectional survey design, should be conducted on GPs and on patients who drop out from CCBT programs. Similar studies should also be conducted on psychologists, since they are the practitioners to whom GPs refer patients for CCBT. Lastly, studies on the effectiveness of CCBT should be made readily available to health practitioners, especially GPs, in order to increase their knowledge about using CCBT for depression.