Brief Cognitive-Behavioral Therapy for Depression in Community Clinics: A Hybrid Effectiveness-Implementation Trial
Abstract
OBJECTIVE: The authors examined whether brief cognitive-behavioral therapy (bCBT) for depression, delivered by mental health providers in community-based outpatient clinics (CBOCs) of the Veterans Health Administration, improved depression outcomes and was feasible and acceptable in clinical settings. METHODS: The authors used a type-2 hybrid effectiveness-implementation, patient-randomized trial to compare bCBT with enhanced usual care. Participants (N=189) with moderate symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) were enrolled from CBOCs in the southern United States. bCBT (N=109) consisted of three to six sessions, delivered by mental health providers (N=17) as part of routine clinic practices. Providers received comprehensive training and support to facilitate bCBT delivery. Recipients of enhanced usual care (N=80) were given educational materials and encouraged to discuss treatment options with their primary care provider. The primary effectiveness outcome was PHQ-9-assessed depression symptoms posttreatment (4 months after baseline) and at 8- and 12-month follow-ups. Implementation outcomes focused on bCBT dose received, provider fidelity, and satisfaction with bCBT training and support. RESULTS: bCBT improved depression symptoms (Cohen's d=0.55, p<0.01) relative to enhanced usual care posttreatment, and the improvement was maintained at 8- and 12-month follow-ups (p=0.004). bCBT participants received a mean±SD of 3.7±2.7 sessions (range 0-9), and 64% completed treatment (≥3 sessions). Providers delivered bCBT with fidelity and reported that bCBT training and support were feasible and effective. CONCLUSIONS: bCBT had a modest treatment footprint of approximately four sessions, was acceptable to participants and providers, was feasible for delivery in CBOCs, and produced meaningful sustained improvements in depression.
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Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Multiple Imputation for Nonresponse in Surveys
Rubin, D. B. (1987) · Wiley Series in Probability and Statistics · doi:10.1002/9780470316696 · Cited by 20,701 · see citing works
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
Bush, K. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.16.1789 · Cited by 6,196 · see citing works
Malhi, G. S., & Mann, J. J. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31948-2 · Cited by 4,099 · see citing works
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012) · Medical Care · doi:10.1097/mlr.0b013e3182408812 · Cited by 4,058 · see citing works
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.8.1261 · Cited by 1,836 · see citing works
Six-item screener to identify cognitive impairment among potential subjects for clinical research
Callahan, C. M., Unverzagt, F. W., Hui, S. L., Perkins, A. J., & Hendrie, H. C. (2002) · Medical Care · doi:10.1097/00005650-200209000-00007 · Cited by 1,499 · see citing works
Wu, Y., Levis, B., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., Rice, D. B., Boruff, J., Cuijpers, P., Gilbody, S., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291719001314 · Cited by 423 · see citing works
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021) · American Psychologist · doi:10.1037/amp0000722 · Cited by 374 · see citing works
Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy.
Galovski, T. E., Blain, L. M., Mott, J. M., Elwood, L. S., & Houle, T. T. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0030600 · Cited by 286 · see citing works
How much psychotherapy is needed to treat depression? A metaregression analysis
Cuijpers, P., Huibers, M., Daniel Ebert, D., Koole, S. L., & Andersson, G. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.02.030 · Cited by 258 · see citing works
Almirall, D., Compton, S. N., Gunlicks‐Stoessel, M., Duan, N., & Murphy, S. A. (2012) · Statistics in Medicine · doi:10.1002/sim.4512 · Cited by 223 · see citing works
Applications of Methodologies of the Veterans Health Study in the VA Healthcare System
Kazis, L. E., Miller, D. R., Skinner, K. M., Lee, A. F., Ren, X. S., Clark, J. A., Rogers, W. H., Spiro, A., Selim, A. J., Linzer, M., et al. (2006) · Journal of Ambulatory Care Management · doi:10.1097/00004479-200604000-00011 · Cited by 178 · see citing works
Brief Psychotherapy for Depression: A Systematic Review and Meta-Analysis
Nieuwsma, J. A., Trivedi, R. B., McDuffie, J., Kronish, I., Benjamin, D., & Williams, J. W. (2012) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.43.2.c · Cited by 135 · see citing works
Use of Psychotherapy by Rural and Urban Veterans
Cully, J. A., Jameson, J. P., Phillips, L. L., Kunik, M. E., & Fortney, J. C. (2010) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2010.00294.x · Cited by 93 · see citing works
Self-citationCully, J. A., Stanley, M. A., Petersen, N. J., Hundt, N. E., Kauth, M. R., Naik, A. D., Sorocco, K., Sansgiry, S., Zeno, D., & Kunik, M. E. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4101-3 · Cited by 72 · see citing works
Self-citationRosen, R. C., Ruzek, J. I., & Karlin, B. E. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.07.009 · Cited by 63 · see citing works
Kirchner, J. E., Cody, M., Thrush, C. R., Sullivan, G., & Rapp, C. G. (2004) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287335 · Cited by 49 · see citing works
The use of unequal randomisation in clinical trials--An update.
Peckham, E., Brabyn, S., Cook, L., Devlin, T., Dumville, J., & Torgerson, D. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.05.017 · Cited by 47 · see citing works
A Systematic Review of Cognitive Behavioral Therapy for Depression in Veterans
Hundt, N. E., Fletcher, T. L., Robinson, A. J., & Cully, J. A. (2014) · Military Medicine · doi:10.7205/milmed-d-14-00128 · Cited by 46 · see citing works
Self-citationImpact of Distance and Facility of Initial Diagnosis on Depression Treatment
Pfeiffer, P. N., Glass, J. E., Austin, K., Valenstein, M. M., McCarthy, J. F., & Zivin, K. (2011) · Health Services Research · doi:10.1111/j.1475-6773.2010.01228.x · Cited by 42 · see citing works
Johnson, A. L., Ecker, A. H., Fletcher, T. L., Hundt, N., Kauth, M. R., Martin, L. A., Curran, G. M., & Cully, J. A. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/iby116 · Cited by 27 · see citing works
Self-citationLee, A. A., Sripada, R. K., Hale, A. C., Ganoczy, D. A., TRIVEDI, R. B., Arnow, B. A., & Pfeiffer, P. N. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000645 · Cited by 20 · see citing works
Kirchner, J. E., Owen, R. R., Dockter, N. E., Kramer, T. L., Henderson, K., Armitage, T., & Allee, E. (2008) · American Journal of Medical Quality · doi:10.1177/1062860607313144 · Cited by 10 · see citing works
Datapoints: Treatment for New Episodes of Depression
McCarthy, J. F., Bambauer, K. Z., Austin, K., Jordan, N., & Valenstein, M. M. (2007) · Psychiatric Services · doi:10.1176/appi.ps.58.8.1035 · Cited by 8 · see citing works
Boykin, D. M., Wray, L. O., Funderburk, J. S., Holliday, S., Kunik, M. E., Kauth, M. R., Fletcher, T. L., Mignogna, J., Roberson, R. B., & Cully, J. A. (2022) · Journal of Clinical and Translational Science · doi:10.1017/cts.2022.430 · Cited by 5 · see citing works
Self-citationThe impact of integrating physical health into a brief CBT approach for medically ill veterans
Brandt, C. P., Deavers, F., Hundt, N. E., Fletcher, T. L., & Cully, J. A. (2020) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09634-2 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Alavi, S. M. A., Irani, R. D., Fattahi, P., & Pakseresht, S. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05413-4 · Cited by 30 · see citing works
Carey, M., Kerr‐Gaffney, J., Strawbridge, R., Hieronymus, F., McCutcheon, R. A., Young, A. H., & Jauhar, S. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.04.070 · Cited by 5 · see citing works
Shepardson, R. L., Weisberg, R. B., Wade, M., Maisto, S. A., & Funderburk, J. S. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.107 · Cited by 3 · see citing works
SEÇİLMİŞ, H. H., Toraman, O. İ., & Alkar, Ö. Y. (2026) · Klinik Psikoloji Dergisi · doi:10.57127/kpd.26024438.1788010
Shepardson, R. L., Johnson, E. M., Gass, J. C., Wade, M., & Funderburk, J. S. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122217
- Authors
- Cully, J. A., Hundt, N. E., Fletcher, T., Sansgiry, S., Zeno, D., Kauth, M. R., Kunik, M. E., & Sorocco, K.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- ORCID
- Venue
- Psychiatric Services
- Published
- 2024-03-01
- Volume
- 75
- Issue
- 3
- Pages
- 237-245
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W4386507643
- Cited by
- 5
- References
- 28
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- brief cognitive behavioral therapy, depression, community-based outpatient clinics, Veterans Health Administration, hybrid effectiveness-implementation trial, treatment acceptability, treatment feasibility, usual care
- MeSH terms
- Patient Health Questionnaire, Ambulatory Care Facilities, Depression, Humans, Mental Health, Cognitive Behavioral Therapy
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