Study: Computer-assisted cognitive behavioral therapy improved depression in primary care patients

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Computer-assisted cognitive-behavioral therapy improved symptoms of depression in primary care patients compared to usual treatment alone, according to a study published in Open JAMA Network.

One author of the study said that he had a stake in the company that distributed the computer program used in the research and that he consulted with it. The study was funded by a grant from the Agency for Healthcare Research and Quality.

FRONTLINE DATA

Researchers found that patients who used CCBT in addition to regular treatment had “significantly greater improvement” on the Patient Health Questionnaire–9, which is used to screen and measure depressive symptoms. These results were also maintained over time.

“The results of this study show that the treatment of depression in primary care can be improved by adding CCBT to TAU [treatment as usual]“, wrote the study authors. “After 12 weeks of acute treatment, CCBT significantly outperformed TAU in reducing PHQ-9 scores; these positive results were maintained over the 3- and 6-month follow-up intervals. Remission rates more than doubled for CCBT compared to TAU at all time points. »

The authors also noted that the findings were particularly useful for a variety of primary care settings, as many participants came from groups often underrepresented in CCBT research. Nearly 62% of patients in the study reported an annual income of less than $30,000 per year, while about 74% were not college graduates. About 27% of participants were African American, nearly 9% were multiracial, and about 3% were Hispanic.

HOW IT WAS DONE

The study included 175 adult patients who received primary care in clinical practices at the University of Louisville and had a PHQ-9 score of 10 or greater.

The CCBT group included a computer program called Good Days Ahead, up to 12 weekly phone conversations with a therapist plus treatment as usual at their primary care sites. Usual treatment was uncontrolled, but some patients received antidepressants and psychotherapy.

The PHQ-9, Automatic Thoughts Questionnaire for negative thoughts, Generalized Anxiety Disorder–7 survey, and Satisfaction with Life Scale for quality of life were administered at baseline, 12 weeks, three months, and six months after the start of treatment. completed. Participants were enrolled from June 2016 to May 2019, and final follow-up took place in early 2020.

CONTEXT

Mental and behavioral health is a growing sector within digital health. A A report by CB Insights found that funding for mental health and wellness companies increased 139% year-over-year in 2021.

There are a variety of players in the space, including Headspace Health, Modern Health and Meru Health.

CONCLUSION

The study authors said there were some limitations to the study, including using treatment as usual as a control, which cannot compare CBT to regular CBT. They also lacked the resources to draw conclusions about whether factors such as access to a computer or level of education had an impact on efficiency.

But these questions could be addressed in future studies. The researchers also noted that the use of telehealth was not as widespread or accepted by payers at the time of the study.

“Because the study population included people with low incomes and no internet access who were typically underrepresented or not included in previous CCBT surveys, the results suggest that this form of treatment may be acceptable and useful in a variety of settings. primary care,” they wrote. .

“Further studies with larger sample sizes are needed to address implementation procedures that might improve the effectiveness of CCBT and to examine potential factors associated with treatment outcomes.”

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