Reading focus
Syllabus: How Can Effective Psychological Care Reach More People?
Trace the difference between offering a programme, logging in and receiving a meaningful amount of treatment.
Why you’re reading it. Understand how the delivery conditions behind an average effect matter in practice.
A question to consider. How would you redesign the comparison to test therapeutic support without attributing every difference to the software?
Why this reading
Availability is different from engagement. REEACT tests two computerised CBT programmes added to routine primary care and documents how little many participants used them.
Before you read
A pragmatic trial evaluates an offer of treatment under service conditions. Usual care could include other treatments. Telephone contact supplied technical help and encouragement, rather than detailed therapeutic guidance.
Read for
- Compare the programmes offered with the support and sessions actually received.
- Keep the primary four-month comparison separate from secondary findings and the uncertain effects of missing follow-up.
Consider afterwards
- What has a trial established when an offered programme has low use and no clear added benefit?
- How could a follow-up comparison test whether more therapeutic support improves engagement and outcomes?
Editorial context
The trial did not establish added benefit on its primary outcome; it cannot rule out small effects or represent every form of online therapy. A correction clarifies that the primary outcome was changed before the trial began to PHQ-9 alone and that diagnostic-interview depression was not collected at that endpoint. REEACT-2 subsequently tested added telephone facilitation.