A Decade of Digital CBT- Questionable Effectiveness and Advertising Standards Concerned

yet it is at the heart of NHS Talking Therapies, with 635,759 sessions of internet enabled therapy taking place in 2022-23.  Recently an Editorial in the American Journal of Psychiatry bemoaned the dirth of quality evidence in support of Digital Mental Health (DGMH). Nevertheless one of the sponsors of NHS Talking Therapies networking events, Silver Cloud is still proclaiming that its’ computerised CBT has ‘up to a 70% recovery rate’. It is registered in Ireland and The Irish Advertising Standards Authority told me on May 14th 2024 that they ‘have ongoing concerns that the recovery rate statistic continues to change’ and need to investigate and will revert back to me when the investigations are concluded.


A particular concern raised in the American Journal of Psychiatry is that a randomised controlled trial of a digital version of dialectical behaviour therapy (DBT) for suicidal clients vs waiting list found that those who underwent DBT did worse in terms of harming themselves or completed suicide. The Journal suggests that the best evidence for DGMH  comes from a randomised controlled trial of depressed and anxious patients in primary care, assigned to 16 weeks of CBT or treatment as usual. It was indeed the case that at the 4 and 8 week marker those in CBT were outperforming those on the waiting list but by the 12 and 16 week markers there was no difference in PHQ-9 and GAD-7 scores. These authors have engaged in spin to assert that there must be something beneficial about low intensity CBT. The spin is even more in evidence when the authors fail to mention that the comparison for CBT was a waiting list (people don’t expect to improve on a waiting list) rather than a credible attention control condition. It is a striking example of poor methodology. Even these authors appear to operate with a heuristic that ‘there must be something good about low intensity CBT’.

Dr Mike Scott