Scientific Papers
Much research has been conducted on CCBT products. This includes external research and work done by our own researchers and developers.
The following is a two page short paper by FearFighter developer Professor Isaac Marks, MD.
Psychiat Bullet 2004, August. Information technology can pull mental health care advance into the 21st century. Marks IM
Click here to read
Much research has been conducted on CCBT products. This includes external research and work done by our own researchers and developers.
The following is a two page short paper by FearFighter developer Professor Isaac Marks, MD.
Psychiat Bullet 2004, August. Information technology can pull mental health care advance into the 21st century. Marks IM
Click here to read Scientific research papers and clinical testing.
A1. FearFighter: MD Computing, 1999, 16, 4, 44-48. Lessons from pilot tests of computer self help for agora/claustro-phobia and panic. Shaw SC, Marks IM, Toole S.
a) Evidence from pilot test of 23 patients in GP surgery in Wales and in a London tertiary clinic;
b) Naturalistic study;
c) Positive: FearFighter patients improve
A2. FearFighter: Brit J Psychiatry, 2001, 179, 456-459. Reducing demands on clinicians by offering computer-aided self-help for phobia/panic: feasibility study. Mark Kenwright, Sheena Liness, Isaac Marks
a) Evidence from further London pilot study, of 54 self-referrals to a self-help clinic;
b) Naturalistic study;
c) Positive: FearFighter patients improved as much as historical controls with face-to-face CBT;
A3. FearFighter: Psychol Med, 2004, 34, 9-18. Saving clinicians' time by delegating routine aspects of therapy to a computer: a RCT in phobia/panic disorder. Marks IM, Kenwright M, McDonough M, Whittaker M, Mataix-Cols D
a) Evidence from London RCT of 93 outpatients already reviewed by Institute.
b) RCT comparing FearFighter with face-to-face CBT with computer-aided relaxation;
c) Positive: Comparable improvement with FearFighter and with face-to-face CBT, greater than with relaxation. Far less therapist time needed with FearFighter than with face-to-face CBT;
A4. FearFighter: Brit J Psychiat 2004,184, 448-449. Computer-aided self-help for phobia/panic via internet at home: A pilot study. Kenwright M, Marks IM, Gega L, Mataix D
a) Evidence from first 10 UK-wide patients who used FearFighter on the net at home and were screened and supported by phone rather than on a standalone computer with face to face support in a clinic;
b) Naturalistic open study
c) Positive: NetFearFighter patients improved significantly despite not physically attending a clinic and being supported by phone rather than face to face.
A5. FearFighter: Submitted 2004. Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M 2003. RCT in phobia/panic disorder of net-guided self-help with brief live phone support
a) Evidence from 68 phobia/panic UK-wide patients randomised to use the net to access either FearFighter or a contrasting CBT system without exposure;
b) RCT;
c) Positive: Patients improved significantly more to follow-up with netFearFighter than with the contrasting CBT system.
A6. FearFighter: Medical Education, 2002, 6, 1-6 McDonough M, Marks IM Teaching medical students exposure therapy - randomised comparison of face-to-face versus computer instruction.
a) Evidence from 37 London medical students randomised to learn either from a truncated form of FearFighter or in a group face-to-face tutorial;
b) RCT
c) Positive: Knowledge gain from a solo FearFighter session resembled that from a small-group face-to-face tutorial and required far less teacher time.
A7. Cope: J Clin Psychiat, 1998, 58, 358-365. Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: An open US-UK study. Osgood-Hynes DJ, Greist JH, Marks IM, Baer L, Heneman SW, Wenzel KW, Manzo PA, Parkin JR, Spierings CJ, Dottl SL, Vitse HM.
a) Evidence from 41 depressed patients from UK and USA;
b) Naturalistic study
c) Positive: All patients completed self-assessment module, 68 completed self-help program and improved significantly
A8. BTSteps: Brit J Psychiatry, 1998, 172, 406-412. Home self-assessment of OCD. Use of a manual and a computer-conducted telephone interview: two US-UK studies. Marks IM, Baer L, Greist JH, Park JM, Bachofen M, Nakagawa A, Wenzel KW, Parkin JR, Manzo PA, Dottl SL, Mantle JM.
a) Evidence from 2 open studies of OCD patients in the UK and the USA.
b) Naturalistic study of 63 patients;
c) Positive: 84% of patients completed the self-assessment module by phone-interactive-voice response, mostly outside usual office hours. Completion of self-assessment predicted later improvement with BTSteps therapy
A9. BTSteps: MD Computing, 1998, 15, 149-157. Self-treatment for OCD using a manual and a computerized phone interview: A US-UK Study. Greist J, Marks IM, Baer L, Parkin R, Manzo P, Mantle J, Wenzel K, Spierings C, Kobak K, Dottl S, Bailey T, Forman L
a) Evidence from completers of 1st open study of OCD patients in the UK and the USA from A8 above;
b) Naturalistic study of 35 completers of the self-assessment module;
c) Positive: The 17 completers of at least 2 sessions of exposure and ritual prevention improved significantly in OCD
A10. BTSteps: J Clinical Psychiatry, 1999, 60, 8, 545-549. Home self-assessment and self-treatment of obsessive compulsive disorder using a manual and a computer-conducted telephone interview: replication of a US-UK study. Bachofen M, Nakagawa A, Marks IM, Park JM, Greist JG, Baer L, Wenzel KW, Parkin JR, Dottl SL.
a) Evidence from completers of 2nd open study of OCD patients from A8 above, in the UK;
b) Naturalistic study of 16 completers of the self-assessment module.
c) Positive: The 10 completers of at least 2 sessions of exposure and ritual prevention improved significantly in OCD, mood and disability, as much as is usual with medication
A11. BTSteps: J Telemedicine and Telecare, 2000, 6, 22-26. Self treatment of obsessive compulsive disorder guided by a manual and computer-conducted telephone interview. Nakagawa A, Marks IM, Park JM, Bachofen M, Baer L, Dottl SL, Greist JH
a) Further evidence from completers of 2nd open study of OCD patients from A6 above, in the UK;
b) Naturalistic study of completers of the self-assessment module.
c) Positive: Improvement of the 10 completers resembled that of matched historical controls who had face-to-face CBT;
A12. BTSteps: J Clin Psychiatry, 2002, 63; 138-145. Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control: Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch, MJ, Mantle JM, Clary CM
a) Evidence collected from RCT of OCD patients in the USA and Canada;
b) Multicentre RCT of 200 patients from 8 centres in North America comparing outcome of CCBT with therapist-led CBT (TCBT) and with relaxation. CCBT patients accessed CCBT at home by phone via interactive voice response technology;
c) Positive: With a new delivery paradigm via phone-interactive voice response at home, improvement was as great with CCBT as with TCBT, and more so than with relaxation, while dropouts were (non-significantly) fewer with CCBT than with TCBT;
A13. BTSteps: Submitted 2004. Effect of brief scheduled clinician's phone calls on computer-aided self-help for obsessive-compulsive disorder: RCT: Kenwright M, Marks IM, Graham C, Franses A
a) Evidence from 2nd RCT of 44 OCD patients in the UK;
b) RCT. In half the patients the therapist scheduled regular brief phone support; the other half had brief phone support on demand.
c) Positive: Compared to on-demand support, brief scheduled phone support increased use of CCBT and improvement in a new delivery paradigm via phone-interactive voice response at home
A14. FearFighter, Cope, BTSteps: Brit J Psychiatry 2003, 183; 57-65 Pragmatic evaluation of computer-aided self help for anxiety and depression. Marks IM, Mataix-Cols D, Kenwright K, Cameron R, Hirsch S, Gega L
a) Evidence from open UK study;
b) Analysis of patient uptake, satisfaction, outcome and dropout in pragmatic investigation of 355 referrals for CCBT in an NHS primary care clinic using 4 CCBT systems.
c) Positive: Patients used CCBT well and with satisfaction, distress and disability improved significantly, and dropout rates resembled those with face to face therapy.
A15. FearFighter, Cope, BTSteps: J Clin Psychol / In Session, 2004, 60, 1-11. Computer-aided CBT Self Help for Anxiety and Depressive Disorders: Experience of a London clinic and future directions. Gega L, Marks IM, Mataix-Cols D
a) Evidence from case history studies of operation of CCBT in UK cohort from A4 above;
b) Detailed description of CCBT cases from A1. above.
c) Positive: Patients improved substantially
A16. FearFighter, Cope, BTSteps: Submitted 2004. Screening suitability of anxiety/depression sufferers for guided self-help. Gega L, Kenwright M, Mataix-Cols D, Cameron R, Marks IM
a) Evidence collected from comparison of suitability for CCBT rated from self-completed questionnaires and from interviews, in UK patients.
b) Data from 196 self-referrals' answers to a screening questionnaire whose diagnosis and suitability for CCBT were rated from their answers and then independently re-rated by 3 clinicians in a face to face interview; analysis was of inter-clinician reliability of interview-based ratings and of agreement between clinicians' ratings from questionnaire answers and from interviews.
c) Positive: Good inter-clinician agreement on diagnosis and suitability at interview and on diagnosis from questionnaire answers, and pointers on how to further improve the questionnaire
A17. FearFighter, Cope, BTSteps: Submitted 2004: Effect of referral source on outcome with CBT self-help: Mataix-Cols D, Cameron R, Gega L, Kenwright M, Marks IM
a) Evidence from naturalistic UK study;
b) Analysis of effect of source of referral on outcome in 355 referrals to a CCBT self-help clinic
c) Positive: GP referrals improved the most with CCBT self-help. Mental-health-professional referrals were more severe, less motivated and improved less
A18. FearFighter, Cope, BTSteps: Psychiatric Bulletin, 2000, 24, 331-332. Psychotherapy by computer: a postal survey of responders to a teletext article. Graham C, Franses A, Kenwright M, Marks IM
a) Evidence omitted from Oct 02 Guidance no. 51: open study of would-be CCBT users in the UK
b) Analysis of a postal survey of responders to a teletext article about self-help
c) Positive: Of 113 responders 27% did not wish to access self-help via their GP; 91% wanted self-help via a computer, 56% via phone-IVR, 43% at home on a CD-ROM, 23% at a computer in a MHRC, and 16% on a computer elsewhere.
A1. FearFighter: MD Computing, 1999, 16, 4, 44-48. Lessons from pilot tests of computer self help for agora/claustro-phobia and panic. Shaw SC, Marks IM, Toole S.
a) Evidence from pilot test of 23 patients in GP surgery in Wales and in a London tertiary clinic;
b) Naturalistic study;
c) Positive: FearFighter patients improve
A2. FearFighter: Brit J Psychiatry, 2001, 179, 456-459. Reducing demands on clinicians by offering computer-aided self-help for phobia/panic: feasibility study. Mark Kenwright, Sheena Liness, Isaac Marks
a) Evidence from further London pilot study, of 54 self-referrals to a self-help clinic;
b) Naturalistic study;
c) Positive: FearFighter patients improved as much as historical controls with face-to-face CBT;
A3. FearFighter: Psychol Med, 2004, 34, 9-18. Saving clinicians' time by delegating routine aspects of therapy to a computer: a RCT in phobia/panic disorder. Marks IM, Kenwright M, McDonough M, Whittaker M, Mataix-Cols D
a) Evidence from London RCT of 93 outpatients already reviewed by Institute.
b) RCT comparing FearFighter with face-to-face CBT with computer-aided relaxation;
c) Positive: Comparable improvement with FearFighter and with face-to-face CBT, greater than with relaxation. Far less therapist time needed with FearFighter than with face-to-face CBT;
A4. FearFighter: Brit J Psychiat 2004,184, 448-449. Computer-aided self-help for phobia/panic via internet at home: A pilot study. Kenwright M, Marks IM, Gega L, Mataix D
a) Evidence from first 10 UK-wide patients who used FearFighter on the net at home and were screened and supported by phone rather than on a standalone computer with face to face support in a clinic;
b) Naturalistic open study
c) Positive: NetFearFighter patients improved significantly despite not physically attending a clinic and being supported by phone rather than face to face.
A5. FearFighter: Submitted 2004. Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M 2003. RCT in phobia/panic disorder of net-guided self-help with brief live phone support
a) Evidence from 68 phobia/panic UK-wide patients randomised to use the net to access either FearFighter or a contrasting CBT system without exposure;
b) RCT;
c) Positive: Patients improved significantly more to follow-up with netFearFighter than with the contrasting CBT system.
A6. FearFighter: Medical Education, 2002, 6, 1-6 McDonough M, Marks IM Teaching medical students exposure therapy - randomised comparison of face-to-face versus computer instruction.
a) Evidence from 37 London medical students randomised to learn either from a truncated form of FearFighter or in a group face-to-face tutorial;
b) RCT
c) Positive: Knowledge gain from a solo FearFighter session resembled that from a small-group face-to-face tutorial and required far less teacher time.
A7. Cope: J Clin Psychiat, 1998, 58, 358-365. Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: An open US-UK study. Osgood-Hynes DJ, Greist JH, Marks IM, Baer L, Heneman SW, Wenzel KW, Manzo PA, Parkin JR, Spierings CJ, Dottl SL, Vitse HM.
a) Evidence from 41 depressed patients from UK and USA;
b) Naturalistic study
c) Positive: All patients completed self-assessment module, 68 completed self-help program and improved significantly
A8. BTSteps: Brit J Psychiatry, 1998, 172, 406-412. Home self-assessment of OCD. Use of a manual and a computer-conducted telephone interview: two US-UK studies. Marks IM, Baer L, Greist JH, Park JM, Bachofen M, Nakagawa A, Wenzel KW, Parkin JR, Manzo PA, Dottl SL, Mantle JM.
a) Evidence from 2 open studies of OCD patients in the UK and the USA.
b) Naturalistic study of 63 patients;
c) Positive: 84% of patients completed the self-assessment module by phone-interactive-voice response, mostly outside usual office hours. Completion of self-assessment predicted later improvement with BTSteps therapy
A9. BTSteps: MD Computing, 1998, 15, 149-157. Self-treatment for OCD using a manual and a computerized phone interview: A US-UK Study. Greist J, Marks IM, Baer L, Parkin R, Manzo P, Mantle J, Wenzel K, Spierings C, Kobak K, Dottl S, Bailey T, Forman L
a) Evidence from completers of 1st open study of OCD patients in the UK and the USA from A8 above;
b) Naturalistic study of 35 completers of the self-assessment module;
c) Positive: The 17 completers of at least 2 sessions of exposure and ritual prevention improved significantly in OCD
A10. BTSteps: J Clinical Psychiatry, 1999, 60, 8, 545-549. Home self-assessment and self-treatment of obsessive compulsive disorder using a manual and a computer-conducted telephone interview: replication of a US-UK study. Bachofen M, Nakagawa A, Marks IM, Park JM, Greist JG, Baer L, Wenzel KW, Parkin JR, Dottl SL.
a) Evidence from completers of 2nd open study of OCD patients from A8 above, in the UK;
b) Naturalistic study of 16 completers of the self-assessment module.
c) Positive: The 10 completers of at least 2 sessions of exposure and ritual prevention improved significantly in OCD, mood and disability, as much as is usual with medication
A11. BTSteps: J Telemedicine and Telecare, 2000, 6, 22-26. Self treatment of obsessive compulsive disorder guided by a manual and computer-conducted telephone interview. Nakagawa A, Marks IM, Park JM, Bachofen M, Baer L, Dottl SL, Greist JH
a) Further evidence from completers of 2nd open study of OCD patients from A6 above, in the UK;
b) Naturalistic study of completers of the self-assessment module.
c) Positive: Improvement of the 10 completers resembled that of matched historical controls who had face-to-face CBT;
A12. BTSteps: J Clin Psychiatry, 2002, 63; 138-145. Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control: Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch, MJ, Mantle JM, Clary CM
a) Evidence collected from RCT of OCD patients in the USA and Canada;
b) Multicentre RCT of 200 patients from 8 centres in North America comparing outcome of CCBT with therapist-led CBT (TCBT) and with relaxation. CCBT patients accessed CCBT at home by phone via interactive voice response technology;
c) Positive: With a new delivery paradigm via phone-interactive voice response at home, improvement was as great with CCBT as with TCBT, and more so than with relaxation, while dropouts were (non-significantly) fewer with CCBT than with TCBT;
A13. BTSteps: Submitted 2004. Effect of brief scheduled clinician's phone calls on computer-aided self-help for obsessive-compulsive disorder: RCT: Kenwright M, Marks IM, Graham C, Franses A
a) Evidence from 2nd RCT of 44 OCD patients in the UK;
b) RCT. In half the patients the therapist scheduled regular brief phone support; the other half had brief phone support on demand.
c) Positive: Compared to on-demand support, brief scheduled phone support increased use of CCBT and improvement in a new delivery paradigm via phone-interactive voice response at home
A14. FearFighter, Cope, BTSteps: Brit J Psychiatry 2003, 183; 57-65 Pragmatic evaluation of computer-aided self help for anxiety and depression. Marks IM, Mataix-Cols D, Kenwright K, Cameron R, Hirsch S, Gega L
a) Evidence from open UK study;
b) Analysis of patient uptake, satisfaction, outcome and dropout in pragmatic investigation of 355 referrals for CCBT in an NHS primary care clinic using 4 CCBT systems.
c) Positive: Patients used CCBT well and with satisfaction, distress and disability improved significantly, and dropout rates resembled those with face to face therapy.
A15. FearFighter, Cope, BTSteps: J Clin Psychol / In Session, 2004, 60, 1-11. Computer-aided CBT Self Help for Anxiety and Depressive Disorders: Experience of a London clinic and future directions. Gega L, Marks IM, Mataix-Cols D
a) Evidence from case history studies of operation of CCBT in UK cohort from A4 above;
b) Detailed description of CCBT cases from A1. above.
c) Positive: Patients improved substantially
A16. FearFighter, Cope, BTSteps: Submitted 2004. Screening suitability of anxiety/depression sufferers for guided self-help. Gega L, Kenwright M, Mataix-Cols D, Cameron R, Marks IM
a) Evidence collected from comparison of suitability for CCBT rated from self-completed questionnaires and from interviews, in UK patients.
b) Data from 196 self-referrals' answers to a screening questionnaire whose diagnosis and suitability for CCBT were rated from their answers and then independently re-rated by 3 clinicians in a face to face interview; analysis was of inter-clinician reliability of interview-based ratings and of agreement between clinicians' ratings from questionnaire answers and from interviews.
c) Positive: Good inter-clinician agreement on diagnosis and suitability at interview and on diagnosis from questionnaire answers, and pointers on how to further improve the questionnaire
A17. FearFighter, Cope, BTSteps: Submitted 2004: Effect of referral source on outcome with CBT self-help: Mataix-Cols D, Cameron R, Gega L, Kenwright M, Marks IM
a) Evidence from naturalistic UK study;
b) Analysis of effect of source of referral on outcome in 355 referrals to a CCBT self-help clinic
c) Positive: GP referrals improved the most with CCBT self-help. Mental-health-professional referrals were more severe, less motivated and improved less
A18. FearFighter, Cope, BTSteps: Psychiatric Bulletin, 2000, 24, 331-332. Psychotherapy by computer: a postal survey of responders to a teletext article. Graham C, Franses A, Kenwright M, Marks IM
a) Evidence omitted from Oct 02 Guidance no. 51: open study of would-be CCBT users in the UK
b) Analysis of a postal survey of responders to a teletext article about self-help
c) Positive: Of 113 responders 27% did not wish to access self-help via their GP; 91% wanted self-help via a computer, 56% via phone-IVR, 43% at home on a CD-ROM, 23% at a computer in a MHRC, and 16% on a computer elsewhere.
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