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Abstract

Objective:

The authors evaluated the efficacy and durability of a therapist-supported method for computer-assisted cognitive-behavioral therapy (CCBT) in comparison to standard cognitive-behavioral therapy (CBT).

Method:

A total of 154 medication-free patients with major depressive disorder seeking treatment at two university clinics were randomly assigned to either 16 weeks of standard CBT (up to 20 sessions of 50 minutes each) or CCBT using the “Good Days Ahead” program. The amount of therapist time in CCBT was planned to be about one-third that in CBT. Outcomes were assessed by independent raters and self-report at baseline, at weeks 8 and 16, and at posttreatment months 3 and 6. The primary test of efficacy was noninferiority on the Hamilton Depression Rating Scale at week 16.

Results:

Approximately 80% of the participants completed the 16-week protocol (79% in the CBT group and 82% in the CCBT group). CCBT met a priori criteria for noninferiority to conventional CBT at week 16. The groups did not differ significantly on any measure of psychopathology. Remission rates were similar for the two groups (intent-to-treat rates, 41.6% for the CBT group and 42.9% for the CCBT group). Both groups maintained improvements throughout the follow-up.

Conclusions:

The study findings indicate that a method of CCBT that blends Internet-delivered skill-building modules with about 5 hours of therapeutic contact was noninferior to a conventional course of CBT that provided over 8 additional hours of therapist contact. Future studies should focus on dissemination and optimizing therapist support methods to maximize the public health significance of CCBT.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 242 - 250
PubMed: 28969439

History

Received: 20 January 2017
Revision received: 21 March 2017
Revision received: 1 June 2017
Accepted: 5 July 2017
Published online: 3 October 2017
Published in print: March 01, 2018

Keywords

  1. Cognitive Therapy
  2. Mood Disorders-Depression
  3. Psychotherapy
  4. Computer-Assisted Therapy

Authors

Details

Michael E. Thase, M.D. [email protected]
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Jesse H. Wright, M.D., Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Tracy D. Eells, Ph.D., M.B.A.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Marna S. Barrett, Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Stephen R. Wisniewski, Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
G.K. Balasubramani, Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Paul McCrone, Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.
Gregory K. Brown, Ph.D.
From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville; the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; and King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London.

Notes

Address correspondence to Dr. Thase ([email protected]).

Funding Information

National Institute of Mental Health10.13039/100000025: R01-MH082794, R01-MH082762
Supported by NIMH grants R01-MH082762 (to Dr. Wright) and R01-MH082794 (to Dr. Thase).Dr. Thase has served as an adviser or consultant to Acadia, Alkermes, Allergan (Forest, Naurex), AstraZeneca, Cerecor, Eli Lilly, Fabre-Kramer Pharmaceuticals, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson (Janssen, Ortho-McNeil), Lundbeck, MedAvante, Merck, Moksha8, Nestlé (Pamlab), Neuronetics, Novartis, Otsuka, Pfizer, Shire, Sunovion, and Takeda; he has received grant support from the Agency for Healthcare Research and Quality, Alkermes, Assurex, Avanir, Forest Pharmaceuticals, Janssen, Intracellular, NIMH, Otsuka Pharmaceuticals, and Takeda; he has received royalties from American Psychiatric Press, Guilford Publications, Herald House, and W.W. Norton; and his spouse works for Peloton Advantage, which did business with Pfizer and AstraZeneca. Dr. Wright receives royalties from American Psychiatric Publishing, Guilford Press, and Simon & Schuster; he is the lead author of the Good Days Ahead (GDA) program used in this investigation and has an equity interest in Empower Interactive and Mindstreet, developers and distributors of GDA; he receives no royalties or other payments from sales of this program, and his conflict of interest is managed with an agreement with the University of Louisville. The other authors report no financial relationships with commercial interests.

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