Computer-Based CBT May Be Effective at Treating Depression Among Individuals Who Are Low Income

Unemployed businesswoman depressed sitting on a path due to company bankrupted while coronavirus spreading situation
Study participants were randomized to receive a computer-assisted cognitive behavioral therapy program or usual care which consisted of up to 12 telephonic support sessions provided by a master’s level mental health clinician.

Individuals with depressive symptoms who have a lower income and lack of internet access benefited more from computer-assisted cognitive behavioral therapy (CCBT) than usual care. These findings were published in JAMA Network Open.

Patients (N=174) with symptoms of depression were recruited for this randomized clinical trial at the practices of the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville between 2016 and 2020. Study participants were randomized to receive CCBT (n=94) which comprised 12-weeks of a 9-lesson Good Days Ahead (GDA) computer program or usual care (n=80) which consisted of up to 12 telephonic support sessions provided by a master’s level mental health clinician.

For individuals without internet access, the study included the loan of low-cost laptops for those who requested them (9.7%). The primary outcome was change in the Patient Health Questionnaire-9 (PHQ-9) score at up to 6 months.

The CCBT and control cohorts were 80.9% and 88.8% women, 61.2% and 59.7% were White, 25.8% and 31.6% were currently receiving psychotherapy, 23.4% and 24.1% were using antidepressants, the primary psychiatric diagnosis was major depression for 80% and 86.3%, 61.3% and 76.3% were high school graduates, and the most common annual income bracket was $14,999 or below (48.6% and 40.8%), respectively.

Compared with usual care, PHQ-9 scores were more greatly reduced by CCBT at 12 weeks (mean difference [MD], -2.5; P =.005), 3 months (MD, -2.3; P =.006), and 6 months (MD, -3.2; P =.01). A similar pattern was observed for the Automatic Thoughts Questionnaire and the Satisfaction With Life Scale. For the Generalized Anxiety Disorder-7 assessment, significant group differences were observed for the first 2 follow-ups but were no longer significantly different at 6 months.

The remission rates were 27.3% (95% CI, 16.4%-38.2%) for the CCBT and 12.0% (95% CI, 3.3%-20.7%) for the usual care cohorts. The dropout rate was lower among the CCBT recipients (22.1% vs 30.0%) and CCBT recipients reported a higher level of treatment satisfaction (P <.001).

Among the CCBT cohort, the number of completed GDA modules completed associated with greater symptom improvement (estimate, -0.85; 95% CI, -1.49 to -0.22; P =.009).

One adverse event was observed in this study, in which 1 participant randomized to receive usual care died by suicide at month 4 of the study.

This study may have been limited by the use of usual care as the comparator. It remains unclear whether CCBT is more effective than other interventions.

“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 authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Wright JH, Owen J, Eells TD, et al. Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial. JAMA Netw Open. 2022;5(2):e2146716. doi:10.1001/jamanetworkopen.2021.46716