Effectiveness and Implementation of Brief Cognitive Behavioral Therapy in CBOCs

Depression is a serious health condition that places tremendous burden on patients and
healthcare systems and is especially prevalent in Veterans. In 2008, the VHA released the
Uniform Mental Health Services Handbook (Handbook 1160.01) in an effort to expand services
for Veterans with depression, including those in primary care and CBOC settings.

The VA remains a national leader in mental health services, but the provision of
psychotherapy within VA is limited, especially for rural Veterans and those cared for in
CBOCs. The VA has invested significant resources to improve access to high-quality mental
health care, including a rapid expansion into CBOCs. Currently, there is a need to work with
clinicians and stakeholders to address practice barriers related to mental health practices
in CBOCs. A recent survey of 4,200 mental health providers in VA found that, although robust
expansion and improved quality of mental health care services has occurred, access to proven
effective psychotherapies in CBOCs remains a focused area for improvement. The study will
examine whether existing VA CBOC mental health clinicians, with training and support, can
effectively administer a structured brief cognitive behavioral therapy (bCBT) intervention
for Veterans with clinically elevated symptoms of depression.

Inclusion Criteria:

- must have clinically significant symptoms of depression;

- must be current recipients of services at CBOCs associated with the Houston and
Oklahoma City VAMCs.

Exclusion Criteria:

- cognitive impairment;

- presence of bipolar, psychotic or substance-abuse disorders.

- Veterans currently receiving psychotherapy WILL be excluded.