Computer-assisted cognitive behavioral therapy improved depression symptoms in primary care patients compared with just treatment as usual, according to a study published in JAMA Network Open.
One study author reported having equity interest in, and consulting with, the company that distributed the computer program used in the research. The study was funded by a grant from the Agency for Healthcare Research and Quality.
Researchers found patients who used CCBT in addition to regular treatment led to “significantly greater improvement” on the Patient Health Questionnaire–9, used to screen for and measure depressive symptoms. Those results also held up over time.
“Results of this study show that treatment for depression in primary care can be enhanced by the addition of CCBT to TAU [treatment as usual],” the study’s authors wrote. “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 were more than double for CCBT compared with TAU at all time points.”
The authors also noted the results were particularly valuable for diverse primary care settings, since many participants came from groups that are often underrepresented in CCBT research. Nearly 62% of patients in the study reported annual income of less than $30,000 a year, while about 74% weren’t 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 at University of Louisville clinical practices and scored 10 or higher on the PHQ-9.
The CCBT group included a computer program called Good Days Ahead, as many as 12 weekly phone conversations with a therapist plus treatment as usual at their primary care sites. Treatment as usual was uncontrolled, but some patients received antidepressants and psychotherapy.
The PHQ-9, the Automatic Thoughts Questionnaire for negative thoughts, the Generalized Anxiety Disorder–7 survey and the Satisfaction with Life Scale for quality of life were administered at baseline, at 12 weeks, at three months and at six months after the treatment was completed. Participants were enrolled from June 2016 to May 2019, and the final follow-up occurred in early 2020.
Mental and behavioral healthcare is a booming sector within digital health. A report by CB Insights found funding for mental health and wellness companies grew 139% year-over-year in 2021.
There are a variety of players in the space, including Headspace Health, Modern Health and Meru Health.
The study’s authors said there were some limitations to the study, including using treatment as usual as a control, which can’t compare CCBT to regular CBT. They also didn’t have the resources to make any conclusions about whether factors like access to a computer or education level had an impact on effectiveness.
But those issues could be addressed in future studies. Researchers also noted that telehealth use was not as widespread or accepted by payers when the study was conducted.
“Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings,” they wrote.
“Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome.”