The computer-assisted CBT (CCBT) entailed fewer visits with a therapist than standard CBT, theoretically increasing efficiency and lowering costs. “With increasing utilization of computers in society, improvements in broadband speed and access, and continued work on enhancing the quality of online CCBT programs, computer-assisted methods that reduce costs and improve the efficiency of psychotherapy offer a valuable means to make treatment available to larger numbers of people with depression,” wrote Michael Thase, M.D., of the Perelman School of Medicine at the University of Pennsylvania and colleagues.
The researchers randomized a total of 154 medication-free patients with major depressive disorder to either 16 weeks of standard CBT (up to 20 sessions of 50 minutes each over 16 weeks) or 16 weeks of CCBT using the “Good Days Ahead” (GDA) program, consisting of the nine Internet-delivered modules of GDA and 12 sessions with a therapist. The modules used a blend of video illustrations, psychoeducation from a psychiatrist-narrator, feedback to users, mood graphs to measure progress, interactive skill-building exercises that help users apply CBT methods in daily life, and quizzes to assess comprehension and promote learning. A clinician dashboard allowed therapists to assess progress, view learning exercises, and coordinate all aspects of treatment.
The CBT group received 8.3 more hours of therapist contact than the CCBT group, which corresponds to 10 fewer 50-minute visits across 16 weeks. Both groups experienced large improvements and similar rates of symptom reduction across the 16 weeks of treatment. Among those who completed treatment, remission rates (defined as a score ≤7 on the Hamilton Depression Rating Scale) at week 16 were 46.9% (30/64) for the CCBT group and 48.4% (30/62) for the CBT group. These improvements were maintained in both groups at follow-up visits three and six months later. Among the 55 participants who had remitted at week 16 and completed the follow-up, only six relapsed (11%), two in the CBT group (7%) and four in the CCBT group (16%).
“Because CCBT reduces the ‘dose’ of therapist time, it is possible that this form of treatment would be less effective than standard CBT for patients with higher symptom severity or more complex, long-standing depressions,” Thase and colleagues wrote. “We also did not enroll patients who wanted to receive concomitant antidepressant therapy, which may have skewed sampling toward a subset of patients who were more highly motivated for psychotherapy. It would be worthwhile in future research to study a wider range of depressed patients, including those who prefer combined treatment with antidepressants and those have not obtained an adequate response to pharmacotherapy.”
For related information, see the Psychiatric News article “Online CBT-I Program May Reduce Depression, Anxiety Symptoms” and the Psychiatric Services article “Technology in Mental Health: Creating New Knowledge and Inventing the Future of Services.”