Delivery of Brief Cognitive Behavioral Therapy for Medically Ill Patients in Primary Care: A Pragmatic Randomized Clinical Trial

Background Few studies have examined the practical effectiveness and implementation potential of brief psychotherapies that integrate mental and physical health. Objective To determine whether an integrated brief cognitive behavioral therapy (bCBT), delivered by mental health providers in primary care, would improve depression, anxiety and quality of life for medically ill veterans. Design Pragmatic patient-randomized trial comparing bCBT to enhanced usual care (EUC). Participants A total of 302 participants with heart failure and/or chronic obstructive pulmonary disease (COPD) with elevated symptoms of depression and/or anxiety were enrolled from two Veterans Health Administration primary care clinics. Intervention bCBT was delivered to 180 participants by staff mental health providers ( n = 19). bCBT addressed physical and emotional health using a modular, skill-based approach. bCBT was delivered in person or by telephone over 4 months. Participants randomized to EUC ( n = 122) received a mental health assessment documented in their medical record. Main Measures Primary outcomes included depression (Patient Health Questionnaire) and anxiety (Beck Anxiety Inventory). Secondary outcomes included health-related quality of life. Assessments occurred at baseline, posttreatment (4 months), and 8- and 12-month follow-up. Key Results Participants received, on average, 3.9 bCBT sessions with 63.3% completing treatment (4+ sessions). bCBT improved symptoms of depression ( p = 0.004; effect size, d = 0.33) and anxiety ( p