CoSMoS: Cognitive Behavioural Therapy Software for the ...
The CoSMoS Pilot Trial
CBT Software for the treatment of depression in people with Multiple
Outcomes of the study
To explore the acceptability and appropriateness of
computerised cognitive behavioural therapy (CCBT)
packages for the treatment of depression in people with MS;
To test the feasibility of undertaking a randomised controlled
trial (RCT) to compare usual care with use of CCBT in
depression for people with MS.
Twenty people with multiple sclerosis and mild or moderate
depression will be consented and allocated to one of two
computerised cognitive behavioural therapy packages: Beating
The Blues or MoodGym. Views on the acceptability and
appropriateness of the treatment will be collected during two
semi-structured interviews and from weekly evaluation sheets.
The transcribed texts will form the basis for a framework
analysis, which is suitable for policy research. Feedback will be
provided to the software manufacturers who will be able to
make their software more appropriate for people with multiple
The outcomes of the study will be (1) indication of the impact of
CCBT on depression in multiple sclerosis (2) a well researched
protocol for a definitive RCT of the effectiveness of CCBT in
treating depression in people with multiple sclerosis and (3) a
computerised CBT software product developed in response to the
views of people with multiple sclerosis.
Half of all people with multiple sclerosis experience major
depression during the course of their lifetime. Cognitive
Behavioural Therapy (CBT) is a talking therapy which has been
shown to be effective for treatment of depression, generally and
in multiple sclerosis. However, access to CBT is very limited, as
there are too few therapists and many patients are reluctant to
enter face-to-face therapy.[2,3]
The study is led by researchers from the University of Sheffield
and the team includes people with personal experience of MS, a
consultant neurologist and clinical psychologists.
RCT evidence demonstrates that a particular computerised CBT
(CCBT) package Beating The Blues - is more effective for the
treatment of depression than standard (drug) treatment,[4,5] and
is recommended for use in the NHS. However CCBT has not
been designed specifically for use by, or evaluated in people with
multiple sclerosis and may not be appropriate or effective for use
by people with physical disabilities and cognitive symptoms.
A pilot trial of the effectiveness of CCBT in multiple sclerosis will
be undertaken. Either Beating The Blues or MoodGym, whichever
is most acceptable to people with multiple sclerosis, will be
compared with standard care for mild or moderate depression.
Twenty-four people will be consented into the study and will be
randomised to usual care or CCBT. Participants in the usual care
arm will be offered CCBT at the end of the study. Those in the
CCBT arm will be further randomised to undertake the sessions at
home or in a community facility.
1. Siegert RJ, 2005. Depression in multiple sclerosis: a review. Journal of Neurology Neurosurgery
and Psychiatry, 76:469-79.
2. House of Commons Select Committee on Health, 2000. Fourth Report on the Provision of Mental
Health Services. HM Stationary Office: London.
3. Shapiro DA, 2003. Geographical Inequity in the Availability of Cognitive Behavioural Therapy in
England and Wales. Behavioural & Cognitive Psychotherapy, 31:185-92.
4. Proudfoot, J. 2004. Clinical efficacy of computerised cognitive behavioural therapy for anxiety and
depression in primary care: randomised control trial. British Journal of Psychiatry, 185:46-54.
5. Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, Parry G, Rooney G, Sutcliffe
P, 2006. Computerised cognitive behaviour therapy for depression and anxiety update: a
systematic review and economic evaluation. Health Technology Assessment, 10(33):1-168.
6. National Institute for Health and Clinical Excellence, 2006. Computerised cognitive behaviour
therapy for depression and anxiety Review of Technology Appraisal 51. NICE: London.
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