title: Online cognitive behavioral therapy for depressed primary care patients: a pilot feasibility project.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Pilot feasibility project.
  
  
  METHODS
  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.
authors.affiliation: Research Associate at the Group Health Research Institute in Seattle, WA. whiteside.u@ghc.org.
authors.forename: Ursula
authors.initials: U
authors.lastname: Whiteside
authors.affiliation: Project Manager at the Group Health Research Institute in Seattle, WA. richards.je@ghc.org.
authors.forename: Julie
authors.initials: J
authors.lastname: Richards
authors.affiliation: Assistant Medical Director of Behavioral Health Services at Group Health Cooperative in Seattle, WA. steinfeld.b@ghc.org.
authors.forename: Bradley
authors.initials: B
authors.lastname: Steinfeld
authors.affiliation: Physician-Psychiatrist in Behavioral Health Services at Group Health Cooperative and an Investigator at the Group Health Research Institute in Seattle, WA. simon.g@ghc.org.
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
authors.affiliation: Research Specialist at the Group Health Research Institute in Seattle, WA. caka.s@ghc.org.
authors.forename: Selin
authors.initials: S
authors.lastname: Caka
authors.affiliation: Scientific Editor for Group Health Research Institute in Seattle, WA. tachibana.c@ghc.org.
authors.forename: Chris
authors.initials: C
authors.lastname: Tachibana
authors.affiliation: Regional Manager of Behavioral Health Services at Group Health Cooperative in Seattle, WA. stuckey.s@ghc.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stuckey
authors.affiliation: Research Associate at the Group Health Research Institute in Seattle, WA. ludman.e@ghc.org.
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
mesh_terms: D015928:Cognitive Behavioral Therapy; D003142:Communication; D003625:Data Collection; D003863:Depression / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D020407:Internet; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011320:Primary Health Care; D015397:Program Evaluation; D059020:Suicidal Ideation; D016896:Treatment Outcome