LOS ANGELES — A new study examined the feasibility, acceptability and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) vs. usual primary care (UC).
Researchers from the VA Greater Los Angeles Healthcare System and UCLA’s David Geffen School of Medicine in Los Angeles advised that internet-based cCBT can effectively treat depression but is not widely used, including in the VHA where it was freely available for veterans. “We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation,” they wrote in General Hospital Psychiatry.1
Their pilot randomized controlled trial (RCT) included 57 VA primary-care patients receiving either cCBT-CC or UC. The participants had Patient Health Questionnaire (PHQ-9) scores of 10+, with veterans diagnosed with serious mental illness (e.g., bipolar depression, schizophrenia and active suicidality) being excluded.
Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative-care manager support and overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline.
The researchers collected blinded information about feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8) and potential effectiveness (PHQ-9) at baseline and 3 months.
Participants—29 receiving cCBT-CC and 28 having usual care—had a mean age of 50 and were 70% male. About 32% were white, 32% Hispanic and 25% Black; in addition, 21% gad experienced homelessness. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0), and 39 % reported suicidal thoughts/behaviors.
The authors advised that 72 % of 94 primary-care providers, from 6 out of the 8 participating clinics, helped support their patients’ participation. During the trial, cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed a mean 6.7 out of 11 cCBT lessons.
The results indicated that participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; p = 0.02) symptoms from pretreatment to post-treatment. “There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, -0.01; p = 0.05),” the researchers advised.
They concluded, “cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.”
- Leung LB, Brayton CE, Hovsepian S, Karakashian MA, et. Al. Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial. Gen Hosp Psychiatry. 2025 Sep-Oct;96:223-233. doi: 10.1016/j.genhosppsych.2025.07.014. Epub 2025 Jul 29. PMID: 40763603.