More information on COPE
ACRONYMS: CBT = cognitive behaviour therapy; CCBT = computer-aided CBT; IVR= interactive voice response; RCT= randomised controlled trial; TCBT = entirely therapist-guided CBT
1. Cope is an evidence-based form of CCBT for depression. It assumes a reading age of 11. It is individually-tailored and data driven. Confidentiality is assured by password and personal-ID access – only the user’s local referrer can link the ID to personal identifiers. Users are encouraged to complete Cope’s 9 CBT steps within 3 months. Cope has been tested naturalistically in phone-interactive-voice-response (IVR) form including a workbook. It will soon be available nationally in internet form (netCope) to facilitate updates and dispense with its workbook and become the most fully-realised internet-based CCBT for depression.
2. Patients get empowering autonomy by working with Cope which gives consistently good advice without tiring, widens choice, reduces disruption of work and home activities, incurs no drug side effects, and prints advice and homework sheets, progress graphs, and results. Many users say they value Cope’s confidentiality which also reduces stigma.
3. Cope was clinically effective in two naturalistic studies in a total of 80 patients with depression (53 in the UK, 27 in the USA). The studies were in both primary and secondary care settings. Cope was acceptable and yielded significant improvement of symptoms and social adjustment. In the naturalistic open studies:
a) Patients phoned Cope from home and did so mainly outside usual office hours.
b) Cope users needed only a total of about an hour of live phone support by a clinician over 3 months (far less therapist time than is needed for TCBT), allowing a 5-fold rise in the number of depressed patients therapists could treat effectively, or freeing therapists to treat other patients.
c) Cope automatically tracked and reported patients’ ongoing clinical progress e.g. which Cope modules they used and when and for how long, mood, suicidality, social adjustment.
4. Gains with Cope were clinically meaningful, enabling patients to resume normal lives.
5. Cope used at home:
a) meets sufferers’ expressed preference for home-accessed CCBT;
b) eases patient access and widens choice of therapy because selection, password assignment and brief live support work well by phone from a helpline;
c) gives users 24/7 access to Cope with no need to physically attend a clinic, so saving travel time, expense, and child care and other problems ensuing from being away from home and work, and allowing more flexible timing of self-help guidance and homework;
d) enables efficient central updating of Cope;
e) permits central audit of non-personally-identifiable outcome of every user.
6. Staff time to decide referrals’ suitability can be cut to a few minutes if staff quickly read referrals’ answers to a suitability questionnaire and reserve a 15-minute suitability interview to confirm unsuitability only if SQ answers suggest likely unsuitability.
7. Helpline facilitators learned to briefly select and then support Cope users in a few days of training including going through Cope as a `pretend’ patient. Cope thus helps to train professionals and others in CBT and to become facilitators to support patients.
8. CCBT has greater take-up and yields more improvement when it is offered as an early step in primary care rather than as a later step for patients on a CBT waiting list who are already expecting face-to-face care.
9. Cope's efficient central audit capability can provide ongoing automatic outcome-monitoring for audit of individual and aggregated patients. This speeds the meeting of clinical governance and performance criteria of the National Service Framework and makes feasible for the first time the creation of a national clearinghouse of clinical outcome of depression collecting progress data automatically from users round the UK.
10. By its speeding of access to acceptable and effective CBT the wide provision of Cope as an early step in care could eventually reduce:
a) waiting lists for CBT of depression;
b) post-code and other inequity of treatment provision;
c) prevalence and chronicity of, and disability and family burden from, depression;
d) long-term medication use. Allowing GPs to refer depressed/anxious patients to a primary-care CCBT clinic reduced their referrals for secondary-care CBT by 80%.
11. Helpline facilitators learn to briefly assess suitability and then support Cope users in 2 days of training which includes going through Cope as a `pretend’ patient. Cope thus helps to train facilitators, who included mental health professionals and non-clinical administrators.
ACRONYMS: CBT = cognitive behaviour therapy; CCBT = computer-aided CBT; IVR= interactive voice response; RCT= randomised controlled trial; TCBT = entirely therapist-guided CBT
1. Cope is an evidence-based form of CCBT for depression. It assumes a reading age of 11. It is individually-tailored and data driven. Confidentiality is assured by password and personal-ID access – only the user’s local referrer can link the ID to personal identifiers. Users are encouraged to complete Cope’s 9 CBT steps within 3 months. Cope has been tested naturalistically in phone-interactive-voice-response (IVR) form including a workbook. It will soon be available nationally in internet form (netCope) to facilitate updates and dispense with its workbook and become the most fully-realised internet-based CCBT for depression.
2. Patients get empowering autonomy by working with Cope which gives consistently good advice without tiring, widens choice, reduces disruption of work and home activities, incurs no drug side effects, and prints advice and homework sheets, progress graphs, and results. Many users say they value Cope’s confidentiality which also reduces stigma.
3. Cope was clinically effective in two naturalistic studies in a total of 80 patients with depression (53 in the UK, 27 in the USA). The studies were in both primary and secondary care settings. Cope was acceptable and yielded significant improvement of symptoms and social adjustment. In the naturalistic open studies:
a) Patients phoned Cope from home and did so mainly outside usual office hours.
b) Cope users needed only a total of about an hour of live phone support by a clinician over 3 months (far less therapist time than is needed for TCBT), allowing a 5-fold rise in the number of depressed patients therapists could treat effectively, or freeing therapists to treat other patients.
c) Cope automatically tracked and reported patients’ ongoing clinical progress e.g. which Cope modules they used and when and for how long, mood, suicidality, social adjustment.
4. Gains with Cope were clinically meaningful, enabling patients to resume normal lives.
5. Cope used at home:
a) meets sufferers’ expressed preference for home-accessed CCBT;
b) eases patient access and widens choice of therapy because selection, password assignment and brief live support work well by phone from a helpline;
c) gives users 24/7 access to Cope with no need to physically attend a clinic, so saving travel time, expense, and child care and other problems ensuing from being away from home and work, and allowing more flexible timing of self-help guidance and homework;
d) enables efficient central updating of Cope;
e) permits central audit of non-personally-identifiable outcome of every user.
6. Staff time to decide referrals’ suitability can be cut to a few minutes if staff quickly read referrals’ answers to a suitability questionnaire and reserve a 15-minute suitability interview to confirm unsuitability only if SQ answers suggest likely unsuitability.
7. Helpline facilitators learned to briefly select and then support Cope users in a few days of training including going through Cope as a `pretend’ patient. Cope thus helps to train professionals and others in CBT and to become facilitators to support patients.
8. CCBT has greater take-up and yields more improvement when it is offered as an early step in primary care rather than as a later step for patients on a CBT waiting list who are already expecting face-to-face care.
9. Cope's efficient central audit capability can provide ongoing automatic outcome-monitoring for audit of individual and aggregated patients. This speeds the meeting of clinical governance and performance criteria of the National Service Framework and makes feasible for the first time the creation of a national clearinghouse of clinical outcome of depression collecting progress data automatically from users round the UK.
10. By its speeding of access to acceptable and effective CBT the wide provision of Cope as an early step in care could eventually reduce:
a) waiting lists for CBT of depression;
b) post-code and other inequity of treatment provision;
c) prevalence and chronicity of, and disability and family burden from, depression;
d) long-term medication use. Allowing GPs to refer depressed/anxious patients to a primary-care CCBT clinic reduced their referrals for secondary-care CBT by 80%.
11. Helpline facilitators learn to briefly assess suitability and then support Cope users in 2 days of training which includes going through Cope as a `pretend’ patient. Cope thus helps to train facilitators, who included mental health professionals and non-clinical administrators.
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