Wednesday, November 8, 2017

Guided Online CBT Program May Enhance Collaborative Care for Depression, Anxiety

Incorporating a computerized cognitive-behavioral therapy (CCBT) into a collaborative care program may lead to symptom improvements in patients with depression and anxiety beyond those reported by patients receiving usual care from a primary care physician (PCP), according to a study published today in JAMA Psychiatry

“Our report confirms the effectiveness of guided CCBT, highlights the critical importance of patient engagement with online interventions, and provides high-quality evidence about the limits and potential benefits of these emerging technologies,” wrote Bruce L. Rollman, M.D., M.P.H., of the University of Pittsburgh School of Medicine and colleagues.

The researchers recruited patients aged 18 to 75 years who were recently diagnosed with anxiety, generalized anxiety, panic, or depression from 26 primary care offices in Pittsburgh. Study participants were randomly assigned to one of three interventions for six months: (1) care manager–guided CCBT alone, (2) care manager–guided access to both CCBT and a moderated, password-protected Internet support group (CCBT+ISG), or (3) usual care under their PCP. 

Participants assigned to the CCBT program received an email and phone call from a care manager introducing the eight-session Beating the Blues CCBT program, which included text, audiovisual clips, and “homework” assignments on CBT techniques. Patients in the CCBT+ISG group were also encouraged to participate in moderated discussion boards or check out other resources on the Internet support group page. 

Care managers logged into the CCBT program’s portal to monitor patients’ progress, sent personalized feedback and encouragement via email, and called patients who either had not improved or failed to log in regularly. PCPs were regularly updated about their patients’ progress through electronic medical records. Participants in the usual care group were informed of their anxiety and mood symptoms, and referring PCP, but were not given treatment advice unless suicidality or significant worsening of symptoms was captured during assessments at three, six, and 12 months. 

Over the six-month period, 504 of 603 patients (83.6%) with CCBT access started the program and completed an average of 5.4 sessions. Overall, 228 of 302 patients (75.5%) in the CCBT+ISG arm logged into the Internet support group at least once; of these patients, 141 (61.8%) made at least one online comment or post. 

Patients receiving CCBT+ISG or CCBT alone reported significant improvements in mental health–related quality of life and mood and anxiety symptoms compared with patients receiving usual care at six months—improvements that were still evident when patients were reassessed six months after the intervention ended. The researchers also found that the more CCBT sessions the patients completed, the greater the improvement in their symptoms.    

“[A]lthough our ISG [Internet support group] did not produce any measurable benefit over CCBT alone, providing online CCBT to patients with depression and anxiety receiving primary care via a centralized collaborative care program is an effective strategy for delivering mental health care at scale,” the authors concluded.

For related information, see the Psychiatric News article “Early Follow-Up Is Key to Patient Success in Collaborative Care” and the American Journal of Psychiatry article Improving the Efficiency of Psychotherapy for Depression:Computer-Assisted Versus Standard CBT.”

(Image: iStock/izusek)


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