What do primary care clinicians and patients think about internet-based computerized cognitive behavioral therapy for depression? A qualitative study from the Veterans Health Administration.

Abstract

Depression can be effectively treated with internet-based computerized cognitive behavioral therapy (cCBT). The Veterans Health Administration (VHA) provided cCBT free to all veterans nationally as of 2013; however, its uptake has been limited. This study aimed to examine VHA primary care clinicians' and patients' perspectives regarding cCBT treatment for depression. We conducted semistructured interviews with 12 primary care clinicians (September-November 2020) and four focus groups involving 15 patients with depression (March-May 2021). Interview guides were developed using the Consolidated Framework for Implementation Research; questions addressed depression treatment barriers and facilitators, cCBT awareness and acceptability, target patient population for cCBT, and integration into depression management pathways. Data were analyzed for overarching themes using matrix analysis techniques. Few primary care clinicians and patients were aware of cCBT and its availability for veterans. Clinicians stressed the importance of identifying appropriate patients for cCBT use, specifically veterans with mild-to-moderate severity depression. Clinicians believed cCBT could potentially engage patients in depression treatment who may not otherwise engage and envisioned cCBT use to be guided by integrated VHA mental health personnel. Patients spoke of multiple treatment barriers (e.g., long wait times) and, correspondingly, viewed cCBT as facilitating access to mental health treatment. While patients raised some technical questions, they expressed interest in cCBT. Though relatively unknown to participants, cCBT was widely perceived to be acceptable and with the potential to increase access to depression treatment within VHA primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).