Computerized Cognitive Behavioral Therapy Can Be Effective in Mood and Anxiety Disorders
Although effective treatment strategies, collaborative care models are often beset by challenges that serve as barriers to dissemination and implementation.
Guided online, computerized cognitive behavioral therapy (CBT) alone was more effective than primary care physicians' usual care at improving mental health-related quality of life, mood, and anxiety symptoms among patients with depression and anxiety, according to a recent study published in JAMA Psychiatry.
Bruce L. Rollman, MD, MPH, of the Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and colleagues randomly assigned 704 patients to computerized CBT alone, computerized CBT plus an internet support group, or primary care physicians' usual care. Those participating in the first 2 arms of the study received 6 months of guided access to an 8-session computerized CBT program provided by care managers who informed primary care physicians of their patients' progress and promoted patient engagement with online programs.
At the 6-month assessment, patients receiving computerized CBT plus an internet support group reported similar improvements in mental health-related quality of life, mood, and anxiety symptoms compared with patients in the computerized CBT-alone group. In contrast, as compared with those receiving usual care, patients in the computerized CBT-alone group reported significant 6-month effect size improvements in mood (effect size, 0.31) and anxiety (effect size, 0.26) that endured 6 months later. Furthermore, completing more computerized CBT sessions produced greater effect size improvements, suggesting a dose-response effect.
The study has limitations that may affect the ability to generalize the findings, including those intrinsic to the clinicians' electronic medical record systems, lack of information on symptom duration, and the inability to blind patients to the interventions used.
Nonetheless, the authors felt their findings have important implications for transforming the way mental health care is delivered in primary care settings and will provide support for focusing greater attention on the emerging field of e-mental health.
Rollman BL, Belnap BH, Abebe KZ, et al. Effectiveness of online collaborative care for treating mood and anxiety disorders in primary care. A randomized clinical trial [published online November 8, 2017]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2017.3379