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Published Online: 1 August 2011

A Methodological Analysis of Randomized Clinical Trials of Computer-Assisted Therapies for Psychiatric Disorders: Toward Improved Standards for an Emerging Field

Abstract

Objective:

Computer-assisted therapies offer a novel, cost-effective strategy for providing evidence-based therapies to a broad range of individuals with psychiatric disorders. However, the extent to which the growing body of randomized trials evaluating computer-assisted therapies meets current standards of methodological rigor for evidence-based interventions is not clear.

Method:

A methodological analysis of randomized clinical trials of computer-assisted therapies for adult psychiatric disorders, published between January 1990 and January 2010, was conducted. Seventy-five studies that examined computer-assisted therapies for a range of axis I disorders were evaluated using a 14-item methodological quality index.

Results:

Results indicated marked heterogeneity in study quality. No study met all 14 basic quality standards, and three met 13 criteria. Consistent weaknesses were noted in evaluation of treatment exposure and adherence, rates of follow-up assessment, and conformity to intention-to-treat principles. Studies utilizing weaker comparison conditions (e.g., wait-list controls) had poorer methodological quality scores and were more likely to report effects favoring the computer-assisted condition.

Conclusions:

While several well-conducted studies have indicated promising results for computer-assisted therapies, this emerging field has not yet achieved a level of methodological quality equivalent to those required for other evidence-based behavioral therapies or pharmacotherapies. Adoption of more consistent standards for methodological quality in this field, with greater attention to potential adverse events, is needed before computer-assisted therapies are widely disseminated or marketed as evidence based.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 790 - 799
PubMed: 21536689

History

Received: 7 October 2010
Revision received: 22 December 2010
Accepted: 4 February 2011
Published online: 1 August 2011
Published in print: August 2011

Authors

Details

Brian D. Kiluk, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Dawn E. Sugarman, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Charla Nich, M.S.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Carly J. Gibbons, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Steve Martino, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Bruce J. Rounsaville, M.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.
Kathleen M. Carroll, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.

Notes

Address correspondence and reprint requests to Dr. Carroll, Yale University School of Medicine, Department of Psychiatry, VA CT Healthcare Center (151D), 950 Campbell Avenue, West Haven, CT 06516; [email protected] (e-mail).

Funding Information

The authors report no financial relationships with commercial interests.Supported by the National Institute on Drug Abuse (grants P50-DA09241, R37-DA 015969, U10 DA13038, and T32-DA007238) and VISN 1 Mental Illness Research, Education, and Clinical Center.

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