Vanessa G. Ahern

In a recent study of people being treated for depression and mood disorders at primary care facilities, University of Pittsburgh researchers found that those who participated in an interactive online computerized cognitive behavior therapy program (CCBT) called Beat the Blues performed better than those receiving standard primary care alone.But using an online support group, available via smartphone, in conjunction with therapy did not show any additional improvements, according to the study, which spanned 704 adults in the Pittsburgh area and was published in JAMA Psychiatry The Beat the Blues video included tasks and assignments for patients to complete over 6 months. In the study, college students with a mental health background worked as care managers sending emails, making phone calls, and texting to follow up and see how participants were doing.The study’s lead author Bruce L. Rollman, MD, MPH, director of behavioral health and smart technology at the University of Pittsburgh’s division of general internal medicine, says the results suggest that CCBT will work in primary care in the USA, but he stresses the importance of collaborating with human caregivers who can check in with patients. “It’s more than just giving people a link to a computer program and hope that it will work,” says Rollman.CCBT programs have been used with great success in Australia, England, and the Netherlands. For example, 100,000 people in Australia use The Mood Gym every year, strengthening skills to prevent and manage symptoms of anxiety and depression.Rollman says CCBT could work as an adjunct for patients who do not have access to a therapist when one is recommended. The potential benefit of this form of e-mental health could be determined on a case-by-case basis to low-risk patients with moderate depression and mood disorders.Patients opt out of visiting face-to-face therapists for a range of reasons—they cannot afford co-pays, work/life difficulties, or their rural community has limited access. Rollman does not recommend CCBT to patients who are suicidal, have trauma, physical abuse, or substance abuse, as these patients should be referred to more traditional in-person therapies.In the study, two-thirds of patients were on an antidepressant medication, at baseline, and two-thirds were on antidepressant medications 6 months later, which is typical in primary care treatment. “For primary care physicians, I think that the CCBT delivered through a patient-centered medical home can be an effective first-line treatment for patients presenting with mood and anxiety disorders, and can be delivered at scale as a supplement to any medications a patient may already be getting,” Rollman says. “It could be an alternative to people who have access issues, who have nothing.”The researchers were pleased to see that improvements were durable. On average, people stayed remitted after the intervention program was over for 6 months. “Unlike medications where there can be a relapse, people learned skills,” Rollman says. The researchers found that the more the patient engaged with the intervention, the more the patient improved.“We hope that our study findings have implications in how mental health is delivered in primary care, and also focus further attention on e-mental health in the United States,” Rollman notes. “It is also important to test not only that these programs work, but also the most effective way that they work, which is certainly having a human on the other end, providing encouragement.”