Computer-assisted cognitive behavior therapy (CCBT) may outperform Treatment as Usual (TAU) in helping patients reduce depression, improve 6‑month remission rates

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Study: Com­put­er-assist­ed cog­ni­tive behav­ioral ther­a­py (CCBT) improved depres­sion for pri­ma­ry care patients (Mobi­Health News):

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 … 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.

The Study:

Effect of Com­put­er-Assist­ed Cog­ni­tive Behav­ior Ther­a­py vs Usu­al Care on Depres­sion Among Adults in Pri­ma­ry Care: A Ran­dom­ized Clin­i­cal Tri­al (JAMA Net­work Open). Key Points:

  • Ques­tion: Does com­put­er-assist­ed cog­ni­tive behav­ior ther­a­py (CCBT) plus treat­ment as usu­al (TAU), com­pared with TAU alone, improve treat­ment out­come for depres­sion in pri­ma­ry care patients?
  • Find­ings: In this ran­dom­ized clin­i­cal tri­al of 175 adults, CCBT reduced depres­sion, as mea­sured by the Patient Health Questionnaire–9, to a sig­nif­i­cant­ly greater extent than TAU and was asso­ci­at­ed with remis­sion rates that were more than dou­ble those observed for TAU.
  • Con­clu­sions: The find­ings of this ran­dom­ized clin­i­cal tri­al sug­gest that CCBT with a mod­est amount of clin­i­cian sup­port has poten­tial for wider-spread imple­men­ta­tion as an effec­tive, accept­able, and effi­cient treat­ment for depres­sion in pri­ma­ry care. The method of CCBT described here may be use­ful in pri­ma­ry care patients with depres­sion who have low lev­els of income, edu­ca­tion, or read­ing pro­fi­cien­cy as well as in those who lack inter­net access.

The Study in Context: