In the Journals

Study reaffirms efficacy of computerized cognitive behavioral therapy for mood, anxiety disorders

Bruce L. Rollman

Providing access to an internet support group did not provide additional benefit to computerized cognitive behavioral therapy; however, computerized therapy alone was more effective than usual care for mood and anxiety disorders.

“Enabled by advances in computer technology, several computerized cognitive behavioral therapy (CCBT) programs have been developed and proven to be as effective as face-to-face therapy at treating depression and anxiety in primary care,” Bruce L. Rollman, MD, MPH, of University of Pittsburgh School of Medicine, and colleagues wrote. “Another recent development has been the rise of internet support groups (ISGs) that offer general health and disease-specific information and enable members to share treatment information and provide peer support. Indeed, some ISGs have evolved into large-scale sites with thousands of members organized into numerous disease-specific groups. Yet despite indications of benefit, to our knowledge, their effectiveness has not been firmly established.”

To determine efficacy of combining ISG with CCBT via a collaborative care program for depression and anxiety, researchers conducted a three-arm randomized clinical trial with blinded outcome assessments among 26 primary care practices in Pittsburgh. Patients were randomly assigned to receive CCBT alone (n = 301), CCBT plus ISG (n = 302) or usual care (n = 101).

Study participants received guided access to an eight-session CCBT program from care managers who informed primary care physicians of patients’ progress and promoted patient engagement via online programs for 6 months.

At 6 months, 84.4% of the CCBT group started the program and completed a mean number of 5.4 sessions and 75.5% of the CCBT plus ISG group logged into the ISG at least once. Of these, 61.8% provided at least one comment or post in the ISG.

Improvements in mental health–related quality of life, mood and anxiety symptoms were similar among participants who received CCBT plus ISG or CCBT only.

However, participants who received CCBT only exhibited greater improvements in mood (effect size = 0.31; 95% CI, 0.09-0.53) and anxiety (effect size = 0.26; 95% CI, 0.05-0.48) that remained 6 months later, compared with those who receive usual care.

Further, completing more CCBT sessions produced greater improvements in effect sizes for mental health–related quality of life and symptoms, according to researchers.

“Although our ISG 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 researchers wrote. “Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention to the emerging field of e–mental health.” – by Amanda Oldt

Disclosures: Rollman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Bruce L. Rollman

Providing access to an internet support group did not provide additional benefit to computerized cognitive behavioral therapy; however, computerized therapy alone was more effective than usual care for mood and anxiety disorders.

“Enabled by advances in computer technology, several computerized cognitive behavioral therapy (CCBT) programs have been developed and proven to be as effective as face-to-face therapy at treating depression and anxiety in primary care,” Bruce L. Rollman, MD, MPH, of University of Pittsburgh School of Medicine, and colleagues wrote. “Another recent development has been the rise of internet support groups (ISGs) that offer general health and disease-specific information and enable members to share treatment information and provide peer support. Indeed, some ISGs have evolved into large-scale sites with thousands of members organized into numerous disease-specific groups. Yet despite indications of benefit, to our knowledge, their effectiveness has not been firmly established.”

To determine efficacy of combining ISG with CCBT via a collaborative care program for depression and anxiety, researchers conducted a three-arm randomized clinical trial with blinded outcome assessments among 26 primary care practices in Pittsburgh. Patients were randomly assigned to receive CCBT alone (n = 301), CCBT plus ISG (n = 302) or usual care (n = 101).

Study participants received guided access to an eight-session CCBT program from care managers who informed primary care physicians of patients’ progress and promoted patient engagement via online programs for 6 months.

At 6 months, 84.4% of the CCBT group started the program and completed a mean number of 5.4 sessions and 75.5% of the CCBT plus ISG group logged into the ISG at least once. Of these, 61.8% provided at least one comment or post in the ISG.

Improvements in mental health–related quality of life, mood and anxiety symptoms were similar among participants who received CCBT plus ISG or CCBT only.

However, participants who received CCBT only exhibited greater improvements in mood (effect size = 0.31; 95% CI, 0.09-0.53) and anxiety (effect size = 0.26; 95% CI, 0.05-0.48) that remained 6 months later, compared with those who receive usual care.

Further, completing more CCBT sessions produced greater improvements in effect sizes for mental health–related quality of life and symptoms, according to researchers.

“Although our ISG 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 researchers wrote. “Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention to the emerging field of e–mental health.” – by Amanda Oldt

Disclosures: Rollman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.