Use of an online cognitive behavioral therapy program either alone, or in combination with online support groups, is a more effective treatment for anxiety and depression than traditional primary care.
Physicians from the University of Pittsburgh presented their study findings at the annual meeting of the Society of General Internal Medicine (SGIM) in Hollywood, Florida.
The randomized trial was 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. Investigators 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.
Patients were assigned to either a care manager-guided access to the eight-session Beating the Blues computerized cognitive behavioral therapy (CCBT) program; a care manager-guided access to both the CCBT program and a password-protected Internet Support Group (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.
Patients randomized to both CCBT and ISG had similar overall improvements in mood and anxiety symptoms compared to patients randomized to only CCBT. However, secondary analysis revealed those who engaged more with the support group 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.
Similarly, although Internet Support Groups have gained prominence in recent years — helping individuals with similar conditions to access and exchange self-help information and emotional support — the benefits of the channel have yet to be established in randomized trials.
Researchers believe their new findings may help to change old paradigms. “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.”