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.

Ryan Wetzler, director of Sleep Health Center in Louisville, will speak at 7 p.m. at Second Presbyterian Church, 3701 Old Brownsboro Road. Wetzler, who is board certified in behavioral sleep medicine and clinical health psychology, will discuss the sleep system, new insomnia treatment guidelines and a revolutionary approach to treating the condition.

He practices cognitive behavioral therapy for insomnia (CBT-I), a treatment that helps people identify and replace thoughts and behaviors that cause or exacerbate sleep problems with habits that promote good sleep.

CBT-I helps people overcome the underlying causes of sleep problems, unlike sleep medications, which are advised only for short-term use – between four to six weeks – because of adverse effects that include learning and memory problems and dependence, Wetzler said.

“CBT-I actually cures a majority of those with chronic insomnia in an average of five treatment visits and enables nearly 80 percent of those taking sleep medication to discontinue use,” Wetzler said.

About 10 to 15 percent of adults experience chronic insomnia and 80-90 percent of depression and anxiety patients have sleep difficulties.

The “Building Hope” lecture series is sponsored by the .

Kogan will discuss the effect of mental illness on Schumann’s music and perform pieces by the composer at the dinner, hosted at the Muhammad Ali Center, 144 N. Sixth St. The event starts at 6 p.m.

Kogan, clinical professor of psychiatry at Weill Cornell Medicine in New York City and artistic director of the Weill Cornell Music and Medicine Program, has given lectures and concerts worldwide that explore the role of music in healing and the influence of psychological factors and illness on the creative output of classical composers.

Nearly 20 years ago, Kogan began investigating psychological issues of composers whose music he had played for years. He discovered that several – including Beethoven, Tchaikovsky and Schumann – presented signs of serious psychiatric illnesses.

The connection between creative genius and mental illness has been well documented, and modern research suggests that the incidence of psychiatric illness is greater among writers, artists and musicians compared to the general population, according to Psychiatric Times.

Schumann, Kogan’s focus at the UofL event, likely had bipolar disorder, which first manifested in a severe depressive episode. Schumann had recurring panic attacks, mood swings and spent the final years of his life in an institution after an attempted suicide. He died in 1856 at age 46.

Kogan recorded the DVD “Music and the Mind: The Life and Works of Robert Schumann” for Yamaha. He has received numerous honors, including the Concert Artists Guild Award, the Liebert Award for Applied Psychoanalysis and the Alexander Award in Psychiatry.

Kogan studied piano at the Juilliard School of Music and earned his undergraduate and medical degrees at Harvard. He has a private practice of psychiatry in New York City.

The dinner benefits the UofL Depression Center, Kentuckiana’s leading resource for depression and bipolar disorder treatment, research and education. Tickets are $125 per person and can be ordered by phone at 502-588-4886 or .

Stephen O’Connor, PhD, associate director of the UofL Depression Center, will present “Understanding and Recovering from Suicidality” at 7:30 p.m. at St. Paul United Methodist Church, 2000 Douglass Blvd. The lecture is sponsored by the and .

Depression is an important topic to focus on for suicide prevention, but there is much more to suicidal experiences that are not explained or characterized by depression, O’Connor said.

“This is a misunderstood topic and we want people to better understand how to conceptualize why people develop suicidal thoughts,” O’Connor said. “Although the majority of people who have suicidal thoughts are experiencing depression, most depressed people are not suicidal. Therefore, the public needs to understand how depression indirectly impacts suicidality, whereas other factors are more directly related to suicide risk.”

The best treatments that help people recover from a suicidal crisis address the experiences and reasons that people have for feeling like death is a good option, he said.

For more information, call the Depression Center at 502-588-4886.

David M. Clark, PhD, professor of experimental psychology at the University of Oxford in England and director of the Oxford Centre of Anxiety Disorders & Trauma, will present “Thrive: How Psychological Therapies Transform Lives and Save Money.” The event is part of the “Building Hope” public lecture series sponsored by the University of Louisville Depression Center and will be held at 6 p.m. at the Clifton Center, 2117 Payne St. 

“Effective psychological treatments are available for most mental health problems, but the public rarely benefits. This can be changed,” Clark said. “The clinical and economic arguments for increasing access to psychological therapies are overwhelming.”

The lecture kicks off the Depression Center’s 12th annual conference at the Clifton Center on Friday, Nov. 2, that will focus on translating science into clinical practice for depression and anxiety disorders.

Conference sessions are geared toward psychiatrists, psychologists, social workers, nurse practitioners, primary care physicians and other mental health clinicians. Focusing on some of the most promising developments in biological psychiatry and psychotherapy, participants will learn about advanced methods for challenging clinical problems. 

Keynote speakers include Clark, Mark A. Frye, MD, professor and chair of the Department of Psychiatry and Psychology at the Mayo Clinic and director of the Mayo Clinic Depression Center, and Laura Wright McCray, MD, associate professor and residency program director of the Department of Family Medicine at the University of Vermont. 

Continuing education credits are available for attendees.

Attendance is free for UofL physicians, nurses, faculty members, students, residents and fellows. For more information, call 502-588-4886 or visit the .

The conference is supported by the American Foundation for Suicide Prevention, Centerstone Kentucky, Norton Healthcare and Passport Health Plan.

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, presented findings during the on Sept. 11 at the UofL Clinical and Translational Research Building.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action () and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

According to the Centers for Disease Control and Prevention, suicide rates have increased 25 percent nationwide, with Kentucky experiencing a 36.6 percent increase between 1999 and 2016.

Researchers with the CDC found that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. Several factors contribute to risk for suicide, including relationship problems, substance misuse, physical health problems and stress tied to jobs, money, legal issues or loss of housing.

, PhD, associate director of the , urges people to reach out to others who they suspect are contemplating suicide.

“The stigma of experiencing suicidal thoughts is often a barrier for people to express what they’re going through. The best way to break that barrier is by having conversations, no matter how uncomfortable they may be,” said O’Connor, a clinical psychologist.

Guidance on conversation starters is available at , a campaign by the that provides video scenarios and other information on reaching out to those who are struggling.

According to the National Institute of Mental Health, the behaviors listed below may be signs that someone is considering suicide:

• Talking about wanting to die or wanting to kill themselves.
• Talking about feeling empty, hopeless or having no reason to live.
• Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills or buying a gun.
• Talking about great guilt or shame.
• Talking about feeling trapped or feeling that there are no solutions.
• Feeling unbearable emotional or physical pain.
• Talking about being a burden to others.
• Using alcohol or drugs more often.
• Acting anxious or agitated.
• Withdrawing from family and friends.
• Changing eating and/or sleeping habits.
• Showing rage or talking about seeking revenge.
• Taking great risks that could lead to death, such as driving extremely fast.
• Talking or thinking about death often.
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy.
• Giving away important possessions.
• Saying goodbye to friends and family.
• Putting affairs in order, making a will.

If you are having thoughts of suicide, several resources are available. Call the National Suicide Prevention Lifeline 24/7 at 1-800-273-8255. The service is available to everyone. The deaf and hard of hearing can contact the line via TTY at 1-800-799-4889. All calls are confidential.

provides emergency psychiatric services 24/7 with specialists who stabilize adults experiencing mental health crisis. To contact emergency psychiatric services, call 502-562-3120.

, which includes the UofL Depression Center, provides treatment for mental health issues including addiction, anxiety disorders, bipolar disorder, depression, geriatric psychiatry and women’s mental health. For appointments, call 502-588-4450.

Active Minds RSO

The University of Louisville has an Active Minds RSO on campus. The group’s mission is to make sure every student knows that mental illness is treatable, suicide is preventable, and help is available.

 indicate there are significant barriers to treatment for people who have made suicide attempts and highlight the need to improve assessment and intervention for survivors of self-inflicted gunshot wounds, especially while hospitalized for their injury.

Stephen O’Connor, PhD, associate director of the , and other researchers analyzed electronic medical records from 128 survivors of self-inflicted gunshot wounds treated at a trauma center in Nashville, between 2012 and 2015 to identify factors associated with denying a suicide attempt to medical staff. Twenty-nine percent of patients denied their injuries resulted from a suicide attempt. Of those cases, 43 percent had questionable circumstances, and the denial of suicide attempt was coded as a suspected false denial.

The study noted cases that appeared to be obvious false denials of suicide. Clinician quotations from medical transcripts included “he shot himself when confronted by police” and “left voicemails on wife’s phone saying goodbye,” according to the study.

O’Connor said people likely deny suicide attempt because of the stigma surrounding the act, not wanting the incident documented on medical records and the reluctance to be admitted to inpatient psychiatric care because of family or job responsibilities.

“As a provider, it’s a friction point when you’re trying to help but you may not be getting the whole story from the patient,” O’Connor said. “The hospital psychiatry consultation and liaison service has to figure out quickly if patients are at imminent risk in the hospital and upon discharge to the community once medically stable.”

Hospitalized patients who denied a suicide attempt were nearly 11 times more likely to be discharged to home rather than to inpatient psychiatric care.

Brief psychological interventions implemented in the hospital while patients recover from potentially intentional, self-inflicted injuries are a solution to treatment barriers. These may include the Safety Planning Intervention, in which a clinician and patient identify warning signs that might precipitate a suicidal crisis and develop coping strategies, and the Teachable Moment Brief Intervention that pinpoints factors underlying a suicide attempt and plans for outpatient mental health services.

Psychiatrist Christopher K. Peters, MD, will present “Youth, Athletics and the Psyche: What Happened to Playing Catch?” at 7 p.m. at Second Presbyterian Church, 3701 Old Brownsboro Road. The “Building Hope” lecture series is sponsored by the UofL Depression Center.

Adults tend to focus on the outcomes of games, and some have a difficult time separating themselves from their child’s participation, said Peters, outpatient director of UofL Physicians-Bingham Clinic.

The talk will promote an understanding to keep coaches and parents from squelching children’s involvement in sports.

“Sports are a vehicle to teach so many life lessons, but most kids drop out of sports before high school and some never engage again,” Peters said. “When we understand the benefits and risks of sport involvement, we can all become part of keeping youth, and ultimately adults, more active and healthier.”

For more information, call the Depression Center at 502-588-4886.

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.