Effectiveness of Computer-Based CBT for Depression Among Veterans
Mindyra Team | March 01, 2020 | Depression, Trauma
This week we will be discussing an article published in January 2020 in the journal, Psychiatric Services in Advance. In this study, authors Pfeiffer, Pope, Houk, Benn-Burton, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, and Valenstein tested whether computerized cognitive behavioral therapy (CBT) combined with peer support from a specialist improved depressive symptoms in Veterans.
What did they do?
The primary aim of this study was to test whether peer supported computerized CBT (PS-cCBT) improved mental health related outcomes in primary care patients. Using a sample of U.S Veteran primary care patients with a new diagnosis of depression, the authors compared differences in general mental health, depressive symptoms, and quality of life in patients who received either PS-cCBT or a usual-care intervention.
Why did they do it?
Depression rates are high, but unfortunately the lack of accessibility and high cost of therapy often prevents many individuals from seeking treatment. The authors highlight the ways in which computer-based psychotherapy has the potential to help alleviate some of these barriers to treatment access, which we have also discussed before as being a promising approach to accessible mental health care. In this study, however, the authors combine computerized CBT with peer specialist support by an individual who has had a personal experience with mental health challenges; this is an approach that is highly unique. The authors predicted that this type of peer support would improve engagement in cCBT and improve effectiveness of symptom alleviation by virtue of decreasing feelings of social isolation.
How did they do it?
This study included a sample of United States Veterans (n = 330) who recently received a diagnosis of depression from a primary care provider. The participants did not have any co-morbid mental health diagnoses, and following a phone screener, were separated into two groups; One group receiving PS-cCBT in combination with their usual primary or integrated care, and another group only receiving enhanced usual care (EUC) for primary care patients with depression in the Veterans Health Administration (VHA). Participants in each group completed measures of depression symptoms, general mental health status, quality of life, and mental health recovery at baseline, 3 months, and 6 months after beginning treatment.
What did they find?
Of the 330 participants (Average age = 52 years, 80% male), 163 were assigned to the EUC group and 167 were assigned to the PS-cCBT group.
Participants who received PS-cCBT had greater improvement in depression symptoms, quality of life, and mental health recovery at the 3 month follow up, and greater improvement in mental health recovery at the 6 month follow up, when compared to the participants who received the EUC treatment only. Additionally, participants in the PS-cCBT group also had higher response rates at both the 3 and 6 month follow up. Respective to PS-cCBT treatment, the number of peer encounters throughout treatment was positively associated with the number of cCBT modules completed. Taken together, PS-cCBT successfully enhanced the usual primary care treatment for depression. With improvements in mental health recovery sustained up to 6 months post onset of treatment.
What does it all mean (our take)?
This wonderful study demonstrated several important findings - notably that increasing accessibility to treatment and increasing patient engagement in a high risk population (in this case, U.S. Veterans) can yield promising outcomes. In this case, findings pertain specifically to patients with depressive symptoms; however, it is reasonable to expect that similar findings could be obtained with other mental health diagnoses.
There are any number of variables that could be deemed “most” important with regard to predicting treatment success...but it is likely that patient engagement (i.e., the patient’s ongoing involvement with the actual intervention) plays a significant role. We feel that continuing efforts, not only to create these novel forms of intervention, but also to ensure patient engagement, will lead to the most promising outcomes in this line of work.