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.

Patients experienced a positive and robust response to online cognitive behavioral therapy (CBT), equaling a traditional in-person CBT treatment course with three times more therapist contact, according to , which published in the March issue of the American Journal of Psychiatry.

While one of the most effective non-pharmacological treatments for depression, traditional in-person CBT poses barriers to those who need treatment.

“Traditional CBT takes a fair amount of time, money and resources, and there aren’t enough cognitive behavioral therapists,” said Jesse Wright, MD, PhD, director of the , Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry in the UofL School of Medicine, and an author of the study. “The technology delivers treatment more efficiently and reduces cost by allowing many more people to be treated by the same therapist.”

For the study, more than 150 medication-free patients with major depressive disorder were randomly assigned to 16 weeks of either traditional CBT, which entails up to 20 sessions of 50 minutes each, or computer-assisted CBT using the  and 12 abbreviated therapy sessions.

The program, which Wright helped develop, consists of nine Internet-based modules that use video, psychoeducation, mood graphs to measure progress and interactive skill-building exercises that help users apply CBT methods in daily life. A dashboard allows clinicians to assess progress and coordinate aspects of treatment.

Both treatment groups experienced significant improvements and similar rates of symptom reduction across the 16 weeks of treatment. Patients with chronic and severe depression benefitted from both treatment courses.

The research was funded by grants totaling more than $2.5 million from the National Institute of Mental Health, the lead federal agency for research on mental disorders and part of the National Institutes of Health.

Jesse Wright, MD, PhD, director of the  and the Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry, will present “Break Through Procrastination: Unlock Your Potential.” The event is part of the “Building Hope” lecture series sponsored by the UofL Depression Center and will be held at 7 p.m. at Second Presbyterian Church, 3701 Old Brownsboro Road.

Wright will explain why people avoid tasks that need to be accomplished and offer methods for overcoming the practice.

“Procrastination saps your strengths,” Wright said. “If you can break free from procrastination, you will liberate your strengths.”

Wright is the principal author of seven books on cognitive behavioral therapy and the first multimedia computer program for depression treatment. He lectures widely on mood disorders, cognitive behavioral therapy, psychopharmacology and computer-aided psychotherapy.