Delivery of Brief Cognitive Behavioral Therapy in Primary Care Improves Mental Health Symptoms in Chronically Ill Veterans
BACKGROUND:
Depression and anxiety are common in primary care, especially among medically ill patients. Few studies have examined brief psychotherapies that integrate mental and physical health. This patient-randomized trial sought to determine whether an integrated brief cognitive behavioral therapy (bCBT) intervention would improve depression, anxiety, and quality of life for medically ill Veterans. Investigators randomized 302 medically ill Veterans (diagnosed with heart failure and/or COPD) who also had elevated symptoms of depression and/or anxiety – to either bCBT (n=180) or enhanced usual care (EUC; n=122). VA staff mental health providers and advanced trainees (n=19) recruited from primary care settings delivered the bCBT in six weekly/biweekly sessions (in-person or by telephone) over four months. Analyses examined post-treatment differences between bCBT and EUC for depression, anxiety, and health-related quality of life (QOL). Assessments occurred at baseline, post-treatment (4 months), and 8- and 12-month follow-ups.
FINDINGS:
- Intervention Outcomes: Integrated bCBT resulted in significant immediate and 12-month improvements related to depression and anxiety. Brief CBT also resulted in significant short-term improvements related to physical health quality of life for Veterans with chronic lung conditions.
- Intervention Implementation Potential: Delivery of bCBT in VA primary care clinics resulted in Veterans receiving an average of 3.9 sessions with high levels of Veteran engagement (84% receiving care) and treatment completion (63% with 4 or more sessions). Telephone delivery of bCBT occurred for 60% of sessions. Veterans and VA providers reported very high satisfaction with bCBT. VA providers (94%) viewed bCBT as being well suited for use within the primary care setting. Veterans (90%) were mostly or very satisfied with the amount of care received during the bCBT program.
IMPLICATIONS:
- Flexible, low-intensity mental health interventions such as bCBT are currently under-utilized in VA.
- Brief CBT, consisting of 4-6 sessions of care, is effective at treating anxiety and depression for medically ill Veterans in the primary care setting.
- Brief CBT is well-suited for delivery in primary care and is viewed as highly satisfactory by Veterans and VA mental healthcare providers.
LIMITATIONS:
- Veterans completed screening procedures before randomization and may represent a more curated sample than found in frontline practice.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 09-088). Drs. Cully, Stanley, Petersen, Hundt, Kauth, Naik, Sansgiry, and Kunik are part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety (IQuEST) in Houston, TX.
Cully J, Stanely M, Petersen N , et al. Delivery of Brief Cognitive Behavioral Therapy for Medically Ill Patients in Primary Care: A Pragmatic Randomized Clinical Trial. Journal of General Internal Medicine. June 20, 2017; Epub ahead of print.
