Online cognitive behavioral therapy for depressed primary care patients: a pilot feasibility project.

CONTEXT Cognitive behavioral therapy (CBT) is a goal-oriented treatment that guides patients to healthy thoughts and behaviors. Internet-delivered CBT with supportive coaching can be as effective as in-person psychotherapy treatment of depression. OBJECTIVE To test the feasibility of engaging depressed primary care patients not currently receiving psychotherapy and to measure the outcomes of Internet-delivered CBT with supportive coaching. DESIGN Pilot feasibility project. MAIN OUTCOME MEASURES 1) Uptake rate. 2) Reduction in depressive symptoms (average score on 20-item Hopkins Symptom Checklist) from baseline to 4-month follow-up. METHODS Medical records data were queried to identify patients experiencing a new episode of depression. Eligible patients were invited via secure messaging (patient and clinician communication using a secure Web site linked to the medical record) to participate in the Internet-delivered CBT program (also known as Thrive), which was algorithm-driven and delivered through didactic segments, interactive tools, and assessments. Patients completed a self-administered online follow-up survey four months after enrollment. RESULTS Of 196 eligible patients who were sent an invitation, 39 (20%) enrolled in the Internet-delivered CBT program. At follow-up, enrolled patients experienced a clinically significant decrease (average = 46%) in depressive symptoms. Suicidal thoughts also decreased both overall and by severity. CONCLUSIONS Seamless, scalable integration of Internet-delivered CBT into health care systems is feasible. The 20% uptake rate suggests that future work should focus on strategies to increase the initial response rate. One promising direction is the addition of "human touch" to the secure message invitation. Depression outcomes suggest promise for systemwide implementation of Internet-delivered CBT programs.