Doctors from the University of Pittsburgh showed that providing an online computerized cognitive behavioral therapy (CCBT) program both alone and in combination with Internet Support Groups (ISG) is a more effective treatment for anxiety and depression than doctors' usual primary care. The preliminary findings were highlighted at the annual meeting of the Society of General Internal Medicine (SGIM) in Hollywood, Florida.
The National Institutes of Mental Health-funded randomized trial, led by Bruce L. Rollman, M.D., M.P.H., professor of medicine and director of the Center for Behavioral Health and Smart Technology at the University of Pittsburgh, enrolled 704 depressed and anxious patients from 26 UPMC-affiliated primary care offices across western Pennsylvania.
Patients 18 to 75 years old were referred into the trial by their UPMC primary care physician between August 2012 and September 2014. 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; care manager-guided access to both the CCBT program and a password-protected ISG patients could access 24/7 via smartphone or desktop computer; or usual behavioral health care from their primary care physician.
Over the six-month intervention, 83 percent of patients randomized to CCBT started the program, and they completed an average of 5.3 sessions. Seventy-seven percent of patients assigned to the ISG logged into the site at least once, and 46 percent provided one or more posts or comments.
Six months later, those patients randomized to CCBT reported significant improvements in their mood and anxiety symptoms and the more CCBT sessions patients completed, the greater the improvement in mood and anxiety symptoms.
Although patients randomized to both CCBT and ISG had similar overall improvements in mood and anxiety symptoms compared to patients randomized to only CCBT, secondary analysis revealed those who engaged more with the ISG tended to experience greater improvements in symptoms.
Several CCBT programs have proven as effective as face-to-face cognitive behavioral therapy at treating mood and anxiety disorders and are used by many patients outside the U.S., but CCBT remains largely unknown and underutilized within the U.S., Dr. Rollman said. ISG that enable individuals with similar conditions to access and exchange self-help information and emotional support have proliferated in recent years, but benefits have yet to be established in randomized trials.
"Our study findings have important implications for transforming the way mental health care is delivered," Dr. Rollman said. "Providing depressed and anxious patients with access to these emerging technologies may be an ideal method to deliver effective mental health treatment, especially to those who live in areas with limited access to care resources or who have transportation difficulties or work/home obligations that make in-person counseling difficult to obtain. We hope that these findings will focus further attention on the emerging field of e-mental health by other U.S. investigators."
Researchers included Dr. Rollman, 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.