In the Journals

Computer-assisted CBT effective for depression

Michael E. Thase

Computer-facilitated cognitive behavioral therapy that incorporated online skill-building modules with therapeutic contact was comparable with conventional therapy for major depressive disorder.

“CBT is the best-studied form of psychotherapy for depression, but its public health significance is limited by the limited availability of trained therapists (especially in public mental health and rural settings) and the cost and inconvenience of treatment,” Michael E. Thase, MD, of University of Pennsylvania, Philadelphia, told Healio.com/Psychiatry. “Computer-facilitated models of CBT [CCBT] can reduce cost and inconvenience by shifting some of therapy to self-guided modules. There is now good evidence that CCBT can have beneficial results, especially when it is coupled with some contact with a therapist.”

To compare efficacy of the “Good Days Ahead” program of CCBT — a nine-module computer course, which included approximately 6 hours of therapist contact — with a “full” approximately 18-hour course of individual CBT, researchers conducted a randomized study among 154 medication-free patients with major depressive disorder. Study participants were randomly assigned to receive 16 weeks of standard CBT (up to 20 50-minute sessions) or CCBT using the “Good Days Ahead” program. Therapist time in CCBT was projected to be one-third of that in CBT.

At week 16, CCBT met a priori criteria indicating it was noninferior to CBT.

Treatment groups did not significantly differ on any psychopathology outcome.

Remission rates were similar between groups, with intent-to-treat rates of 41.6% for CBT and 42.9% for CCBT.

Improvements were maintained throughout follow-up among both treatment groups.

“Our findings confirmed with high certainty that CCBT was as effective as conventional CBT, despite providing only about one-third the therapist contact,” Thase said. “The major implication of this finding is that more depressed patients can be helped, with a large reduction in the per-patient cost of therapy, by using ... CCBT.” – by Amanda Oldt

Disclosures: Thase reports serving as an advisor or consultant for Acadia, Alkermes, Allergan (Forest, Naurex), AstraZeneca, Cerecor, Eli Lilly, Fabre-Kramer Pharmaceuticals, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson (Janssen, Ortho-McNeil), Lundbeck, MedAvante, Merck, Moksha8, Nestlé (Pamlab), Neuronetics, Novartis, Otsuka, Pfizer, Shire, Sunovion and Takeda; receiving grant support from the Agency for Healthcare Research and Quality, Alkermes, Assurex, Avanir, Forest Pharmaceuticals, Janssen, Intracellular, NIMH, Otsuka Pharmaceuticals and Takeda; receiving royalties from American Psychiatric Press, Guilford Publications, Herald House and W.W. Norton; and spouse employment with Peloton Advantage, which did business with Pfizer and AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.

Michael E. Thase

Computer-facilitated cognitive behavioral therapy that incorporated online skill-building modules with therapeutic contact was comparable with conventional therapy for major depressive disorder.

“CBT is the best-studied form of psychotherapy for depression, but its public health significance is limited by the limited availability of trained therapists (especially in public mental health and rural settings) and the cost and inconvenience of treatment,” Michael E. Thase, MD, of University of Pennsylvania, Philadelphia, told Healio.com/Psychiatry. “Computer-facilitated models of CBT [CCBT] can reduce cost and inconvenience by shifting some of therapy to self-guided modules. There is now good evidence that CCBT can have beneficial results, especially when it is coupled with some contact with a therapist.”

To compare efficacy of the “Good Days Ahead” program of CCBT — a nine-module computer course, which included approximately 6 hours of therapist contact — with a “full” approximately 18-hour course of individual CBT, researchers conducted a randomized study among 154 medication-free patients with major depressive disorder. Study participants were randomly assigned to receive 16 weeks of standard CBT (up to 20 50-minute sessions) or CCBT using the “Good Days Ahead” program. Therapist time in CCBT was projected to be one-third of that in CBT.

At week 16, CCBT met a priori criteria indicating it was noninferior to CBT.

Treatment groups did not significantly differ on any psychopathology outcome.

Remission rates were similar between groups, with intent-to-treat rates of 41.6% for CBT and 42.9% for CCBT.

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Improvements were maintained throughout follow-up among both treatment groups.

“Our findings confirmed with high certainty that CCBT was as effective as conventional CBT, despite providing only about one-third the therapist contact,” Thase said. “The major implication of this finding is that more depressed patients can be helped, with a large reduction in the per-patient cost of therapy, by using ... CCBT.” – by Amanda Oldt

Disclosures: Thase reports serving as an advisor or consultant for Acadia, Alkermes, Allergan (Forest, Naurex), AstraZeneca, Cerecor, Eli Lilly, Fabre-Kramer Pharmaceuticals, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson (Janssen, Ortho-McNeil), Lundbeck, MedAvante, Merck, Moksha8, Nestlé (Pamlab), Neuronetics, Novartis, Otsuka, Pfizer, Shire, Sunovion and Takeda; receiving grant support from the Agency for Healthcare Research and Quality, Alkermes, Assurex, Avanir, Forest Pharmaceuticals, Janssen, Intracellular, NIMH, Otsuka Pharmaceuticals and Takeda; receiving royalties from American Psychiatric Press, Guilford Publications, Herald House and W.W. Norton; and spouse employment with Peloton Advantage, which did business with Pfizer and AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.