Mental health therapy for anxiety and depression provided on a patient’s smartphone or computer turned out to be even more effective than a doctor’s usual primary care in new research from the University of Pittsburgh.
The results could raise awareness about computerized cognitive behavioral therapy and how it can help patients who can’t or don’t want to go to therapy in person, said Bruce Rollman, professor of medicine at the Pitt School of Medicine and lead author of the study recently reported in JAMA Psychiatry. Cognitive behavioral therapy is talk therapy that helps people become aware of inaccurate or negative thinking so they can learn how to better respond to challenging situations.
One of Dr. Rollman’s own primary-care patients, Cornelia Davis, 75, of Mount Washington, participated in the research back in 2012 and says the therapy helped her deal with anxiety she was experiencing after the death of her mother. When her father had died, her mother had moved to Pittsburgh from Kittanning to live near Ms. Davis, who had returned to the city after work overseas with the State Department and international college admissions. Ms. Davis said when she lost her mom, she was the only child of an only child, with little support at the time.
“The situation of being alone was one of the things I dealt with primarily,” she said.
It’s estimated that in any two-week period, more than 1 out of 20 Americans have had moderate or severe depressive symptoms. Dr. Rollman explained that for several years now, computerized cognitive behavioral therapy (or CCBT) has been available to people with chronic anxiety and depression and used in the United Kingdom, but it’s not well known in the United States. The program used in the study, Beating the Blues, was adapted from a UK version and is owned by UPMC Health Plan.
“We’re not just giving someone a link and the program magically works,” Dr. Rollman cautioned. “It’s really important that it’s connected to a care manager or care practice to guide someone through the program.”
He said the CCBT is similar to new technologies that have been added to provide support for people with other chronic conditions, such as heart failure and diabetes, help that is traditionally offered in office settings.
Pitt researchers tested how well the computerized therapy and an internet support group could help patients compared to care based on the strongly recommended collaborative care model.
Collaborative care — in which a primary care doctor leads a team that includes care managers, psychiatrists and other mental health experts as needed — provides evidence-based care for the best results in many chronic conditions, Dr. Rollman said.
“These models have been shown to significantly improve outcomes for anxiety and depression,” he said.
The Pitt research enrolled 704 patients with moderate to severe anxiety and depression from 26 UPMC-affiliated primary-care offices in Western Pennsylvania. Doctors referred patients to the trial using a message in their electronic health records.
Eligible patients then were randomized into one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT program; care manager guidance into the same CCBT program plus access to an internet support group; and a primary care physician’s usual care.
Six months later, with 604 patients completing the trial, the group doing CCBT only and the group doing CCBT and internet support both reported significant improvements in their mood and anxiety symptoms compared to the group that had usual care. The internet support group — moderated by experts involved in the study — was found not to add any benefit to patients’ outcomes compared to the computer-based therapy alone.
Although most patients in the one group did participate in the internet support group, Dr. Rollman said, “a conservative analysis didn’t find moderated access to the support group added anything to the CCBT program.”
Researchers assessing patient progress didn’t know which arm of the study patients were in, he said. However, by six months, those using the computerized therapy had lower measures of symptoms of depression and anxiety. Another six months later, the patients reported continued positive results. One age group, 60-75 years old, did seem to have better results with the support group component. The positive results for the CCBT were higher the more a patient engaged with the program.
Ms. Davis said with the computerized therapy, an online support group and phone visits with a care manager, over the six months she noticed her mood improving and had an easier time with daily living.
“I felt better equipped after these sessions to deal with being alone,” she said. “It absolutely was effective.”
Dr. Rollman said the computer-based therapy has been used in Europe for some time, but not with the personal attention applied in the Pitt research.
“It’s the first trial of using CCBT and support groups in this collaborative care,” he said. By using the computer program, he said, the researchers could monitor how engaged patients were.
“We knew how long they were working on it, what questions they were working on,” he said. Trained care managers — college graduates with mental health research experience — would give links to the therapy program and support group, where applicable. Managers would then log in and monitor their patients’ progress, send emailed personalized feedback and encouragement and contact people by phone if they had not shown improvement or weren’t using the program regularly.
Most patients (544 out of the 704 total) were already on some kind of depression or anxiety medication, Dr. Rollman pointed out.
In related research, led by Pitt’s Charles Jonassaint, which focused on the effectiveness of the computerized therapy program among African-American participants, the therapy was found to be as successful as it was among white study subjects.
Dr. Rollman said he believes access to the program isn’t enough to get the positive results:
“It’s really important how you deliver the program.”
He added that more research might discover which groups of people would benefit more from the internet support group and how people can be encouraged to participate in a group, and how Beating the Blues lessons might work in different combinations and sequences.
Dr. Rollman said other Interventions using the computerized therapy might help people with depression who also are undergoing dialysis — or even help those without depression, but with another condition, such as insomnia.
For information about the recent Pitt study, go to http://ottrial.pitt.edu/
Jill Daly: jdaly@post-gazette.com or 412-263-1596.
First Published: November 13, 2017, 12:00 p.m.