Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open U.S.-U.K. study

J Clin Psychiatry. 1998 Jul;59(7):358-65. doi: 10.4088/jcp.v59n0704.


Objective: To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response (IVR) system.

Method: In an open trial, 41 patients from Boston, Massachusetts; Madison, Wisconsin; and London, England, used COPE, a 12-week self-help system for depression. COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered.

Results: All 41 patients successfully completed the self-assessment in the booklets and telephone calls; 28 (68%) also completed the 12-week self-help program. Hamilton Rating Scale for Depression (HAM-D) and Work and Social Adjustment scores improved significantly (41% and 42% mean reduction in the intent-to-treat sample, respectively, p < .001). Eighteen (64%) of the 28 completers were considered responders on the basis of > or = 50% reduction in their HAM-D scores. There was a higher percentage of completers in the pooled U.S. sites (82% vs. 43%), and U.S. completers improved more than those in the United Kingdom (73% vs. 43% were responders). Most (68%) of the calls were made outside usual office hours, Monday-Friday, 9:00 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls (more treatment modules) correlated positively with improvement over 12 weeks. Mean call length for completers was 14 minutes.

Conclusion: A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with mild-to-moderate depression. These preliminary results are encouraging for people who cannot otherwise access ongoing, in-person therapy.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Boston
  • Depressive Disorder / diagnosis
  • Depressive Disorder / therapy*
  • England
  • Female
  • Humans
  • London
  • Male
  • Middle Aged
  • Pamphlets*
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotherapy / methods*
  • Remote Consultation
  • Self Care / methods*
  • Severity of Illness Index
  • Telephone*
  • Therapy, Computer-Assisted*
  • Treatment Outcome
  • United States
  • Videotape Recording