• Sarah E Knowles, Karina Lovell, Peter Bower, Simon Gilbody, Elizabeth Littlewood, and Helen Lester.
• Centre for Primary Care, NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
• BMJ Open. 2015 Nov 30; 5 (11): e008581.

ObjectiveTo explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT).DesignQualitative semistructured interviews with 36 participants.ParticipantsDepressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial.SettingPrimary care settings in England.ResultsParticipant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes.ConclusionsThe study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients.Trial Registration NumberISRCTN91947481.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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