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Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation
Jeffrey A Cully1, Maria E A Armento, Juliette Mott
1Houston VA HSR&D Center of Excellence, Michael E, DeBakey VA Medical Center, Houston, TX, USA. jcully@bcm.edu
Implementation Science : IS
|July 13, 2012
Summary
This study evaluated brief cognitive behavioral therapy (CBT) for depression and anxiety in primary care. Hybrid designs are crucial for advancing mental health treatment implementation in routine practice.
Area of Science:
- Implementation Science
- Clinical Psychology
- Primary Care Medicine
Background:
- Evidence-based psychotherapies for depression and anxiety are underutilized in primary care settings.
- Hybrid effectiveness-implementation designs can assess clinical and implementation outcomes to improve therapy translation into practice.
Purpose of the Study:
- To determine the effectiveness of brief cognitive behavioral therapy (CBT) for depression and anxiety in medically ill primary care patients.
- To examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy for brief CBT.
Main Methods:
- A hybrid type 2 randomized controlled trial involving 320 participants randomized to brief CBT or usual care.
- Mixed methods, including quantitative (intent-to-treat analyses) and qualitative (interviews, surveys) assessments.
- A multifaceted implementation strategy including online training, audit and feedback, and facilitation.
Main Results:
- Effectiveness and implementation outcomes are being assessed using mixed methods.
- Patient outcomes include depression, anxiety, and physical health functioning.
- Implementation outcomes include clinician adoption and fidelity of brief CBT.
Conclusions:
- Hybrid designs are essential for advancing clinical effectiveness and implementation knowledge in healthcare.
- This study highlights the rationale and challenges of using hybrid designs for brief CBT in primary care.
- Hybrid designs offer a promising approach to accelerate advancements in both mental health research and practice.
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