Computer-aided cognitive behaviour therapy.

Dropout rates soar, however, if Internet access to CCBT is open and unmonitored [1] . The coming of age of CCBT as a way of delivering mental health care was recently recognized by its first approval by a government agency. That approval came from the National Institute for Clinical Excellence (NICE), the English regulatory body. NICE [3] now recommends 2 CCBT systems for the National Health Service – Beating the Blues for depression and FearFighter for panic and phobic disorders. Few CCBT systems have dealt with obsessive-compulsive disorder (OCD). There have been case reports of CCBT with OCD [4, 5] and a pilot study of vicarious exposure by CCBT [6, 7] . Most CCBT research on OCD so far has concerned the BTSteps (Behavior Therapy Steps) system [8] , which Tumur et al. [9] and McCrone et al. [10] refer to in this issue. The BTSteps system delivers its CCBT by telephone via a computer-driven interactive voice response (IVR) system which helps the user plan and carry out the selfdirected exposure and ritual prevention that are core features of effective CBT for OCD. The patient directs the computer IVR interview by key presses on the phone, usually at home and mostly outside usual working hours. (In Britain BTSteps has been adapted for use at home on the Internet and is available under the name OCFighter to avoid confusion with a well-known telephone company). Worldwide the demand for cognitive behaviour therapy (CBT) exceeds the availability of therapists. This gap and advances in information technology have catalyzed a rich ferment of research into computer-aided CBT (CCBT). Certain CCBT systems can save much therapist time by allowing most treatment tasks to be delegated to patient-computer interactions. In contrast, therapist time is not saved either by conducting CBT via email, telephone or videoconference exchanges between patient and therapist in real time, or via most virtual reality systems. CCBT also provides guidance personalized to each patient yet perfectly standardized given the same series of patient responses. Fully 175 CCBT studies including 87 randomized controlled trials (RCTs) have just been reviewed in a Maudsley Monograph [1] , and in this journal Emmelkamp [2] discussed technological innovations in psychotherapy including CCBT. The 97 CCBT systems reviewed in the Monograph concerned a wide spectrum of mental health problems. A growing number of CCBT systems are becoming available on the Internet. Users of CCBT on the Internet are more likely to complete it if they are first screened, are then given access by a password, and are then supported briefly by phone, email or face to face.