Computer-assisted Cognitive-Behavior Therapy for Depression in Primary Care

Computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care will be
evaluated in a trial with 320 patients randomly assigned to CCBT or treatment as usual (TAU).
The study will disseminate a therapy method found to be effective in psychiatric settings
into primary care - a setting where there have been significant problems in delivery of
adequate, evidence-based treatment for depression. The study will include a high percentage
of disadvantaged patients - a population that has been largely ignored in previous research
in CCBT. There have been no previous studies of CCBT for depression in primary care that have
enrolled large numbers of disadvantaged patients. The form of CCBT used in this study is
designed to increase access to effective therapy, provide a cost-effective method, and be a
sustainable model for wide-spread use in primary care.

In order to deliver therapy in a practical manner that can be replicated in other primary
care practices, patients with significant symptoms of depression will receive treatment with
an empirically supported computer program that builds cognitive-behavior therapy skills.
Support for CCBT will be provided by telephone and/or e-mail contact with a care coordinator
instead of the face-to-face treatment with a cognitive-behavior therapist that has been a
part of CCBT delivery in mental health settings. Novel features of this treatment program
include: 1) fully detailed and replicable method for integrating clinician support with CCBT
in primary care; 2) delivery of CCBT to a population with high percentage of disadvantaged
patients; 3) integration of CCBT into the primary care delivery model; 4) highly interactive,
multimedia computer program with adaptations for persons who may have lower levels of
education or computer experience; 5) advanced cost-benefit analysis including data on actual
health care utilization and costs; 6) exploration of moderators and predictors of treatment
outcome.

Outcome will be assessed by measuring CCBT completion rate, comprehension of CBT concepts,
and satisfaction with treatment; in addition to ratings of depressive symptoms, negative
thoughts, and quality of life. The cost-effectiveness analysis and exploration of possible
predictors of outcome should help clinicians, health care organizations, and others plan
further dissemination of CCBT in primary care.

Inclusion Criteria:

1. Patient Health Questionnaire score of 10 or above

2. Age 18 or above

Exclusion Criteria:

1. Refusal to provide informed consent

2. Inability to read English text on computer screen

3. Significant suicidal thoughts, intent, plan, or behavior reported on Columbia Suicide
Severity Rating Scale

4. Severe or poorly controlled medical disorders that would interfere with participation
in CCBT (e.g., liver failure, terminal cancer)

5. Dementia or other organic brain disorders that would prevent participation in CCBT

6. Diagnosis of any psychotic disorder or bipolar disorder.