Cognitive behavioral therapy is a highly effective treatment for depression. A number of factors can prevent patients from receiving successful therapy, however. The need for frequent visits – often more than once per week – taking time off work, transportation, the cost of visits or even access to providers trained in this therapy can prevent patients from getting treatment for their depression.
A newly published clinical trial led by University of Louisville physicians has shown that a computer-assisted cognitive behavior (CCBT) therapy can overcome these barriers while providing effective treatment for depression.
Jesse Wright, professor of psychiatry at UofL and director of the UofL Depression Center, documented treatment results for a diverse group of 175 adults for depression. The study, published in JAMA Network Open in February, showed that patients in a primary care setting who participated in CCBT reported significantly greater improvement in their depressive symptoms than those receiving treatment as usual.
“With modest amounts of telephone support from a clinician, CCBT was associated with greater improvement in depression, anxiety and quality of life than usual treatment in a diverse group of primary care patients. We were pleased to see that CCBT had more than double the remission and response rates as usual treatment,” Wright said.
“There has been a historical lack of effective care for depression in the primary care setting,” he said. “Because this study population included people with lower income and lack of internet access, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings.”
Rather than requiring frequent office visits, a patient can engage in CCBT online whenever their schedule allows and from the comfort of their home. A primary care provider can monitor and support the patient’s progress, helping patients who may not desire or be able to see a psychologist or psychiatrist for their therapy.
“Particularly during the COVID pandemic, we have seen how limited appointments are for mental health services and the rise of telemedicine has led to increasing comfort with utilizing technology to support health, which makes computer-assisted cognitive behavioral therapy a great option,” said Laura Bishop, an associate professor and internal medicine-pediatrics physician at UofL and a co-author of the study.
In the study, CCBT participants used the nine-lesson computer program “Good Days Ahead,” along with as many as 12 weekly telephone support sessions with a master’s level therapist, along with the treatment usually provided by the primary care sites.
“I think this is a preferable option for younger patients who often are more comfortable with self-reflection and working through the CCBT on a computer rather than meeting face-to-face with a provider,” Bishop said. “We’ve seen more and more familiarity with wellness and meditation apps over the past few years that have paved the way for CCBT to be widely accepted.”
Wright began work on computer-assisted therapy in the 1990s and led the initial development of Good Days Ahead. In addition to depression, Wright said CCBT also could be adapted to treatment for obsessive-compulsive disorder, anxiety, eating disorders or other conditions.
Patients in the Louisville area can request use of Good Days Ahead through the UofL Depression Center.
Good Days Ahead is being reviewed by the U.S. Food and Drug Administration under a new protocol for certification of therapeutic computer programs.
Wright retains an equity interest in MindStreet Inc., the company that now manages Good Days Ahead.