A newly published clinical trial led by University of Louisville physicians has shown that a computer-assisted cognitive behavior (CCBT) therapy can overcome these barriers while providing effective treatment for depression.

Jesse Wright, professor of psychiatry at UofL and director of the , documented treatment results for a diverse group of 175 adults for depression. The study, published in in February, showed that patients in a primary care setting who participated in CCBT reported significantly greater improvement in their depressive symptoms than those receiving treatment as usual.

“With modest amounts of telephone support from a clinician, CCBT was associated with greater improvement in depression, anxiety and quality of life than usual treatment in a diverse group of primary care patients. We were pleased to see that CCBT had more than double the remission and response rates as usual treatment,” Wright said.

“There has been a historical lack of effective care for depression in the primary care setting,” he said. “Because this study population included people with lower income and lack of internet access, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings.”

Rather than requiring frequent office visits, a patient can engage in CCBT online whenever their schedule allows and from the comfort of their home. A primary care provider can monitor and support the patient’s progress, helping patients who may not desire or be able to see a psychologist or psychiatrist for their therapy.

“Particularly during the COVID pandemic, we have seen how limited appointments are for mental health services and the rise of telemedicine has led to increasing comfort with utilizing technology to support health, which makes computer-assisted cognitive behavioral therapy a great option,” said Laura Bishop, an associate professor and internal medicine-pediatrics physician at UofL and a co-author of the study.

In the study, CCBT participants used the nine-lesson computer program “Good Days Ahead,” along with as many as 12 weekly telephone support sessions with a master’s level therapist, along with the treatment usually provided by the primary care sites.

“I think this is a preferable option for younger patients who often are more comfortable with self-reflection and working through the CCBT on a computer rather than meeting face-to-face with a provider,” Bishop said. “We’ve seen more and more familiarity with wellness and meditation apps over the past few years that have paved the way for CCBT to be widely accepted.”

Wright began work on computer-assisted therapy in the 1990s and led the initial development of Good Days Ahead. In addition to depression, Wright said CCBT also could be adapted to treatment for obsessive-compulsive disorder, anxiety, eating disorders or other conditions.

Patients in the Louisville area can request use of Good Days Ahead through the .

Good Days Ahead is being reviewed by the U.S. Food and Drug Administration under a new protocol for certification of therapeutic computer programs.

Wright retains an equity interest in MindStreet Inc., the company that now manages Good Days Ahead.

After five therapy sessions, study participants reported significantly decreased depressive symptoms, negative thinking and chronic stressors, and experienced improved sleep quality, according to Lynne Hall, DrPH, RN, associate dean of research and professor at the UofL .

Hall presented the findings Sept. 14 at the  State of the Science Congress on Nursing Research in Washington, DC.

“Women caring for children with chronic conditions such as cerebral palsy and cystic fibrosis are at high risk for depressive symptoms,” Hall said. “They have many things to juggle, including caring for the child, administering medications and coordinating physician and therapy visits. They’re stressed and overwhelmed by the amount of care their children require and the number of hours a day it takes.”

About 15 million children in the United States have special health care needs and women constitute 72 percent of the caregivers of those children.

The study findings show that women caring for children with serious health conditions should be screened for depression and that cognitive behavioral therapy (CBT) is an essential treatment for this population, Hall said.

Brief CBT, a short-term, goal-oriented psychotherapy takes a hands-on, practical approach to problem solving and focuses on changing patterns of thinking or behavior to decrease negative thoughts and improve recognition of one’s ability to cope.

For the study, 94 female caregivers with high levels of depressive symptoms were randomly assigned to either a control group or an intervention group, which received five 45 to 60-minute sessions of CBT.

The women also were given homework that centered on examples of cognitive distortions with positive substitutions, a thoughts log and instructions for practicing relaxation.

“A lot of these women said they felt very isolated and there was no one who would listen to them,” said Catherine Batscha, DNP, a psychiatric-mental health nurse practitioner who provided CBT to the study participants. “Because of their child’s care requirements, the women had difficulty getting together with friends because they couldn’t hire a babysitter who knows about medical equipment or complex health conditions, so people were cut off from a lot of social support.”

The study was funded by a $75,000 grant from Passport Health Plan’s  and a $50,000 grant from .