The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: A qualitative study of people with multiple sclerosis

Abstract

Background: People with chronic physical conditions are at elevated risk of depression. Due to a shortage of Cognitive Behavioural Therapy (CBT) practitioners, computerised CBT (CCBT) is recommended for people with mild to moderate depression. We assessed the applicability of CCBT for the treatment of depression in people with multiple sclerosis (MS). Methods: Depth interviews with 17 people with MS and mild to moderate depression who used one of the two CCBT packages for either eight (Beating the Blues; n = 8) or five (MoodGym; n = 9) weekly sessions were analysed using ‘Framework’. Results: Participants found CCBT-use burdensome due to their physical symptoms. In addition to perpetuating social isolation, the lack of human input meant some participants were unable to define problems, set goals or distinguish between events, thoughts and beliefs as required. CCBT did not legitimise their grief over losses concomitant with their MS. They characterised depression symptom inventories as contaminated by somatic symptoms of their MS. One CCBT package (MoodGym) was perceived as using inappropriate case material for people with the symptoms of MS. Conclusions: It is likely that generic CCBT packages for the treatment of depression will need to be adapted for people with chronic physical conditions to maximise their potential for health benefit.

Keywords:

• cognitive therapy
• depression
• multiple sclerosis
• qualitative research
• therapy
• computer-assisted

Acknowledgements

We thank the MS Society for funding the study and 17 generous participants who offered us their views and often also extended their hospitality. We would also like to acknowledge the technical, procedural and moral support of Kathy Griffiths (Australian National University), Charlie Martin and Despina Learmonth (Ultrasis). We are also grateful for the assistance of the MS specialist nursing team at Sheffield Teaching Hospitals NHS Foundation Trust and our study administrator, Karen Beck. Finally, we would like to thank two anonymous reviewers for their insights.