Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice

• Published in: Journal of affective disorders 2021-11, Vol.294, p.745-752
• Main Authors: Bogucki, Olivia E., Craner, Julia R., Berg, Summer L., Miller, Stephanie J., Wolsey, Megan K., Smyth, Kileen T., Sedivy, Sara J., Mack, John D., Johnson, Marcia W., Burke, Lisa M., Williams, Mark W., Katzelnick, David J., Sawchuk, Craig N.
• Format: Article
• Language: English
• Subjects: CBT/cognitive behavior therapy; Depression; Naturalistic; Treatment
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2021.07.061

•CBT for depressive disorder can be delivered in primary care.•Self-reported depression and anxiety symptoms reduced during treatment.•A large proportion of primary care patients can benefit from a population-based approach to care. Individuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care. Of the 1,302 participants with a primary depressive disorder referred by their primary care provider, 435 endorsed moderate to severe depression at baseline and engaged in at least one CBT session. A psychotherapy tracking database was used to collect relevant data, which included demographics, clinical characteristics, treatment outcomes, and CBT intervention use. Participants with moderate to severe depression who participated in CBT reported a significant decrease in depression and anxiety symptoms at the end of treatment (p ≤ .001, d = 0.52–0.78). Rates of reliable change, response, and remission and types of CBT interventions used differed between major and persistent depressive disorders. Multiple limitations must be noted, which are related to the naturalistic study design, inclusion and exclusion criteria, sample operationalization, symptomatic measurement, time-limited and focused assessment, data collection strategies, and psychological services. Together, these temper the conclusions that can be drawn. Significant reductions in depression and anxiety symptoms were reported by participants with depressive disorders who engaged in short-term CBT within primary care. This study indicates that CBT can be implemented within primary care and suggests that primary care patients with depression can benefit from integrated psychological services, supporting population-based models of care.