11/8/2017
PITTSBURGH, Nov. 8, 2017 – Providing an online computerized cognitive behavioral therapy (CCBT) program, both alone and in combination with an Internet Support Group (ISG), is a more effective treatment for anxiety and depression than a doctor’s usual primary care, researchers from the University of Pittsburgh found. Results were published today in JAMA Psychiatry.
Bruce Rollman, M.D., M.P.H., professor of medicine and director of the Pitt Center for Behavioral Health and Smart Technology, led the National Institutes of Mental Health-funded Online Treatment for Mood and Anxiety Disorders Trial, which enrolled 704 depressed and anxious patients from 26 UPMC-affiliated primary care offices across western Pennsylvania.
UPMC primary care physicians referred patients ages 18 to 75 to the trial between August 2012 and September 2014 using an electronic health record prompt. Eligible and consenting patients were then randomized to one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT program (CCBT-alone); care manager-guided access to both the CCBT program and a password-protected, moderated ISG that patients could access at any time via their smartphone or desktop computer (CCBT+ISG); or to their primary care physician’s usual care.
Over the six-month intervention, 86 percent of patients randomized to CCBT started the program and completed an average of 5.4 sessions. Seventy-five percent of patients assigned to the ISG logged into the site at least once, and 62 percent made one or more posts or comments, with an average of 10.5 posts and comments per person. The maximum number of posts and comments from one participant was 306.
Six months later, patients randomized to the CCBT+ISG and CCBT-alone groups both reported significant improvements in their mood and anxiety symptoms versus patients receiving usual care, and these improvements lasted for six months after the end of the intervention. However, the addition of the moderated ISG provided no additional benefit over guided access to CCBT only. Additionally, the more CCBT sessions patients completed, the greater the improvement in their symptoms, highlighting the critical importance of patient engagement with online interventions.
Despite proven effectiveness at treating mood and anxiety disorders and use by many patients abroad, CCBT remains largely unknown and underutilized within the U.S., Rollman said. ISGs that enable individuals with similar conditions to access and exchange self-help information and emotional support have thrived in recent years, but benefits have yet to be established in randomized trials. This trial was the first to examine the effectiveness of incorporating either a CCBT program or an ISG into a collaborative care program for treating depression or anxiety in primary care.
“Providing access to these effective emerging technologies may be an ideal method to deliver mental health treatment to depressed and anxious patients at scale, especially to those who live in areas with limited access to care or personal obligations that make in-person counseling difficult to obtain,” Rollman said. “Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention on the emerging field of e-mental health in the United States.”
This research was supported by National Institutes of Mental Health grant R01-MH093501, and the Beating the Blues program was provided at no cost byAskesis Development Group, a subsidiary of the UPMC Health Plan.
In addition to Rollman, researchers included Bea Herbeck Belnap, Ph.D., Scott D. Rothenberger, Ph.D., Kaleab Abebe, Ph.D., Armando J. Rotondi, Ph.D., Michael Spring, Ph.D., and Jordan F. Karp, M.D., all of the University of Pittsburgh.
