Phil_Thomas comments on Is effective altruism overlooking human happiness and mental health? I argue it is. - Effective Altruism Forum

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Comment author: Phil_Thomas 29 June 2016 10:15:34PM 2 points [-]

What is the actual effect size of CBT run "in the wild" via a scalable delivery mechanism like an app? How much of depression can we expect it to mitigate? Is the main problem to solve here finding a good intervention, or distributing it (i.e. getting people to use the CBT app or whatever)?

From what I can tell, the problem is more with outreach and retention than with effectiveness. Most of what I've read shows that computer based cognitive behavioral therapy (cCBT) is as effective as in-person CBT for anxiety and depression in the context of a RCT. But "in the wild", rates of adherence drop considerably, with estimates of 0.5% and 1% completion in the only two published studies I could find [1,2].

If your server time and ongoing development costs are low enough, though, cCBT could still be a cost effective approach despite poor retention. This assumes that those that fail to complete the training aren’t harmed, but evidence seems to suggest that even partial completion is helpful [1,2]. Note that in study [1], about 15.6% completed 2 or more of the 5 modules, so a larger portion of people at least partially complete the training. I haven’t done a $/DALY estimate, but it would be fairly easy to come up with one with the results from study [1].

[1] A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website. http://www.jmir.org/2004/4/e46/

[2] Usage and Longitudinal Effectiveness of a Web-Based Self-Help Cognitive Behavioral Therapy Program for Panic Disorder. http://www.jmir.org/2005/1/e7/