Category: Treatment - CBT

Symposium

Delivery of Brief CBT in Primary Care: A Pragmatic Clinical Trial

Sunday, November 19
10:15 AM - 11:45 AM
Location: Indigo Ballroom E, Level 2, Indigo Level

Keywords: Primary Care | Depression | Anxiety
Presentation Type: Symposium

Background


Few studies have examined the real-world effectiveness and implementation potential of brief psychotherapies that integrate mental and physical health. 


Objective


To determine whether an integrated brief cognitive behavioral therapy (bCBT), delivered  by mental health providers in primary care, is effective at improving depression, anxiety and medical disease quality of life for medically ill Veterans.


 Methods


Pragmatic patient-randomized trial comparing bCBT to enhanced usual care (EUC).  A total of 302 participants with heart failure and/or chronic obstructive pulmonary disease (COPD) with elevated symptoms of depression and/or anxiety were enrolled from two Veterans Health Administration primary care clinics. Integrated bCBT was delivered to 180 participants by staff mental health providers (n=19) in the primary care setting. BCBT was a modular, skill-based approach using in-person or telephone sessions over 4 months. Participants randomized to EUC (n=122) received a mental health assessment. Primary outcomes included depression (PHQ-9) and anxiety (BAI). Secondary outcomes included health-related quality of life. Assessments occurred at baseline, 4, 8 and 12 months.


Results
According to audio session reviews by CBT experts, intervention fidelity, fell in the good to very good range (adherence mean 6.7 out of 8; competence mean 6.2 out of 8).  Participants randomized to the bCBT intervention received an average of 3.9 sessions (SD = 2.3), 152 (84.4%) received 1 or more sessions, 114 (63.3%) were classified as treatment completers (4 or more sessions), and 62 (34.4%) received all 6 sessions. Of participants who received 1 or more sessions, the mean was 4.6 (SD 1.6).  Overall, 60.3% of sessions were delivered by telephone. BCBT improved symptoms of depression (p=.004; d=0.33) and anxiety (p<.001; effect size, d=0.37) relative to EUC at posttreatment, with effects maintained at 8 and 12 months.  Health-related quality of life improved posttreatment for bCBT participants with COPD but not for heart failure. Health-related quality of life outcomes were not maintained at 12 months.   


 


Conclusions


bCBT integrated in primary care is effective for medically ill veterans. Improvements for both depression and anxiety were modest but persistent.  The impact on physical health outcomes was limited to shorter-term effects and COPD participants.   Integration of physical and emotional health within bCBT is feasible and effective for depression and anxiety, as delivered by providers in real- world primary care settings.

Jeffrey Cully

Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences
Baylor College of Medicine

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