Randomized controlled trail of two types of online cognitive behavioral therapy for rural cardiac patients with depression

Background Rural dwelling compared to urban dwelling individuals face major disparities in access to health care, and cardiac and mental health, including higher levels of depression. Rural patients with cardiac disease and depressive symptoms (DS) do not receive needed therapy because of lack of mental health providers and difficulty accessing care. Cognitive behavioral therapy (CBT) reduces DS in patients with cardiac disease, but in its traditional form (in-person appointments) is inaccessible to most rural patients. Wireless internet technology has the potential to make CBT accessible to rural dwelling cardiac patients. Purpose Our purpose was to compare DS outcomes from two types of remote-delivery CBT: 1) real-time, face-to-face, video-conferenced CBT with a therapist (vcCBT); and 2) self-administered internet-based CBT without a therapist (iCBT). Methods In this randomized controlled comparative effectiveness non-inferiority trial (N = 303, mean age 58 ± 12 years, 49% women) rural cardiac patients who had at least mild-moderate DS underwent 6-8 weeks of CBT delivered as either vcCBT or iCBT. DS were measured using the Patient Health Questionnare-9. Data were collected at baseline, 3, 6 and 12 months. Data were analyzed using mixed models for repeated measures. Results Patients in the vcCBT compared to the iCBT group had similar levels of DS at baseline (11.1±5 vs 10.9±5, p=0.45; respectively). Both intervention groups demonstrated statistically and clinically significant improvements in DS (Figure), which were maintained at 12 months. Neither intervention was superior to the other. Conclusion Both types of intervention were effective at managing DS. Regardless of intervention type, rural cardiac patients experienced meaningful reductions in DS. Remotely delivered CBT shows promise for management of DS in rural cardiac patients who do not have access to mental health care.