5 Recommendations for further research

5 Recommendations for further research

5.1 Future studies of CCBT should be RCTs that include an ITT analysis, to take account of drop-outs, and record and report any adverse effects, including major self-harm or suicide. They should also collect appropriate information on costs and health-related quality of life – that is, data should be collected using generic preference-based measures (in conjunction with condition-specific instruments) because they facilitate the calculation of QALY. They should also attempt to identify the type of individual within any one treatment group (that is, depression, panic/phobia or OCD) most likely to benefit from CCBT. Consideration should be given to undertaking these RCTs within a GP setting, because most patients with depression and anxiety are currently treated in this setting and patients recruited to the trials should not be self-referrers. Consideration should also be given to whether the packages can be used effectively by patients of all ages and from all ethnic groups. The majority of consultees thought that specific RCTs that would be useful include:

  • pragmatic RCTs for CCBT packages in a stepped-care programme

  • comparisons of CCBT with other self-help comparators that are currently used by this patient group, such as bibliotherapy and exercise

  • comparisons of CCBT with placebo

  • comparisons of CCBT with brief and longer duration TCBT as well as group TCBT

  • head-to-head trials between the packages for depression.