Computer-Based Cognitive Behavioral Therapy with Peer Support Provides Greater Improvement of Depression Symptoms
Computer-based psychotherapy has the potential to address many of the barriers to in-person treatment, given its relatively low costs, accessibility, privacy, and flexibility. Prior studies demonstrated computer-based cognitive behavioral therapy (cCBT) as effective for depression. Although peer specialists—individuals with mental health challenges who have been trained and employed to support others in their recovery—have not previously been studied in support of cCBT, they may improve engagement in cCBT and complement its effectiveness by decreasing social isolation and sharing successful self-management strategies. This randomized controlled trial sought to determine whether cCBT combined with peer support improved outcomes relative to enhanced usual care (EUC) for 330 primary care patients with depression who were treated at three Midwestern VA medical centers and two of their associated outpatient clinics. Veterans with a new diagnosis of depression were randomized to three months of peer-supported cCBT (n=167) or EUC (n=163). Main study outcomes included depression symptoms, general mental health status, quality of life, and mental health recovery. Using web-based self-report surveys, Veterans reported on each measure at baseline, three months, and six months post-randomization. Patient characteristics also were assessed.
- Peer-supported cCBT as an add-on to usual primary care treatment for depression was associated with greater improvements in depression symptoms, quality of life, and mental health recovery at three months compared to enhanced usual care alone. Improvements in mental health recovery, although not the other outcomes, were sustained up to six months.
- Remission rates were 14% for Veterans in the peer-supported cCBT group and 6% for Veterans in the EUC group at three months, and 22% and 11%, respectively, at six months.
- The more modest benefits found with peer-supported cCBT should be considered in the context that more than 50% of Veterans also received antidepressant medication with high levels of adherence and over 30% received some in-person psychotherapy.
- Computerized CBT with peer support should be considered for implementation and evaluation in primary care, and adaptations to the computer CBT and peer support components should be considered to further improve effectiveness.
- Due to lower than expected assessment completion, the analyses may have been under-powered to detect small to moderate effects.
This study was funded by HSR&D (IIR 13-310). Dr. Pfeiffer is part of HSR&D’s Center for Clinical Management Research (CCMR) in Ann Arbor, MI.
Pfeiffer P, Pope B, Houck M, et al. Effectiveness of Peer-supported Computer-based Cognitive Behavioral Therapy for Depression among Veterans in Primary Care. Psychiatric Services. March 1, 2020;71(3):256-62.