Online Cognitive Behavioral Therapy Bests Usual Care for Depression and Anxiety

The use of guided computerized cognitive behavioral therapy (CCBT) is superior to usual care for the treatment of depression and anxiety, according to a recent study. However, the addition of an internet support group (ISG) to CBBT did not provide additional symptom improvement.

From August 2012 to September 2014, 2884 patients aged 18 to 75 years were referred by primary care physicians from 26 primary care practices in Pittsburgh, Pennsylvania. Ultimately, 704 patients (mean age 42.7 years) were included in the present analysis.
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Patients were randomly assigned to received CCBT alone (n=301), CCBT+ISG (n=302), or usual care (n=101). The CCBT intervention involved 6 months of guided access to an 8-session program. Primary care physicians were informed of their patients’ progress by the program’s care managers. Intention-to-treat analyses were performed from November 2015 to January 2017.

Ultimately, 604 (85.8%) patients completed the primary 6-month outcome assessment. By 6 months, 254 (84.4%) patients receiving CCBT alone had started the program, while 228 (75.5%) patients receiving CCBT+ISG had logged into the ISG at least once and 141 (61.8%) had left at least 1 comment or post.

Six-month improvement of mental health-related outcomes were similar in the CCBT alone and CCBT+ISG groups. However, at 6 months, the CBBT group experienced significant effect size improvements in mood and anxiety that persisted 6 months later compared with usual care. Furthermore, the completion of more CCBT sessions was associated with greater effect size improvements in mental health-related quality of life and symptoms.

“While providing moderated access to an ISG provided no additional benefit over guided CCBT at improving mental health–related quality of life, mood, and anxiety symptoms, guided CCBT alone is more effective than usual care for these conditions,” the researchers concluded.

—Christina Vogt

Reference:

Rollman BL, Herbeck Belnap B, Hum B, et al. Effectiveness of online collaborative care for treating mood and anxiety disorders in primary care [a randomized clinical trial]. JAMA Psychiatry. 2018;75(1):56-64. doi:10.1001/jamapsychiatry.2017.3379.