Rising concerns about depression and anxiety have people across rural America looking for help, yet resources are stretched thin. There is a program, delivered entirely online, people can access, but how successful is the approach? According to a new study, the online approach shows promise.

Mark Schure, a Montana State University researcher, has found that Thrive, an internet-based interactive platform, was effective in reducing severity of depression and anxiety symptoms among a mostly rural community population of U.S. adults. It also improved functioning and resilience in this population. Findings of his work were published in the Journal of Medical Internet Research in November.

Schure is an assistant professor in the MSU College of Education, Health and Human Development's Department of Health and Human Development. He notes that this research is the first-known of its kind to rigorously evaluate the effect of an internet-based cognitive behavior therapy program to help alleviate depression and anxiety symptoms among a rural adult population.

“We’re hopeful that these results indicate the usefulness of these types of internet-based programs to effectively teach individuals positive skills to manage their depression and anxiety, which could be especially valuable in rural areas — where mental healthcare services can be hard to access,” he says.

Developed and owned by Waypoint Health Innovations, Thrive primarily uses video to deliver confidential evidence-based care to anyone with internet access. Schure adds that Thrive’s algorithms allow it to be tailored to the needs of the person using the program. Thrive’s responses are based on participants’ answers to a series of questions aimed at determining how much they are affected by depression, and which aspects of the program would benefit them the most. And as participants continue using the program, it becomes more personalized.

Modifying behavior

Schure says cognitive behavior therapy is a form of psychotherapy that aims to boost happiness by focusing on behaviors and thoughts. It has been shown to effectively reduce depression symptoms, which can increase risk for suicidal thinking and suicidal behaviors.

In his study, Schure examined the impact of Thrive on nearly 350 adults in Montana who reported at least mild symptoms of depression. The study evaluated participants’ self-reported mental health before they used the program, after using the program for four weeks and again after using the program for eight weeks.

The study’s main outcome of interest was the severity of participants’ depression symptoms as measured by the Patient Health Questionnaire, a common clinical measure. Researchers also measured participants’ anxiety symptoms, work and social adjustment, resilience and frequency of suicidal thoughts. Outcomes were compared between the group receiving Thrive program over the eight-week period and those who had not yet received the program.

The group using the internet-based cognitive behavior therapy program reported significant reductions in depression symptoms over those who had not used the program. In addition, researchers found that using Thrive had moderately positive effects on participants’ anxiety symptoms, work and social functioning, and resilience. The Thrive group was also 45% less likely than the control group to experience increased suicidal thoughts, Schure says. He called the findings encouraging.

The work continues with Schure and colleagues evaluating  whether the positive effects they found are lasting. Also, there is research with a larger sample of 1,000 adult Montanans, and work to develop a similar program for adolescents.

Thrive was launched in Montana in 2017 and reached 464 people in more than 100 communities. The program used in the study conducted by Schure and his colleagues is a culturally adapted version of the original program. The Thrive for Montana research product was supported by a $221,000 grant from the state of Montana after the 2017 Legislature passed, and Gov. Steve Bullock signed, a bill to provide $1 million for suicide prevention in the state. The program also received an added $90,000 in continuing funds from the state. The work was also funded by Montana Idea Network of Biomedical Research Excellence.

Promise for the future

Alison Harmon, dean of the MSU College of Education, Health and Human Development notes that the results are promising. “We need to use every tool we have to address depression, anxiety and the frequency of suicidal thoughts in rural Montana,” she says. “I look forward to an expansion of this work and increased access to Thrive in additional populations.”

“We hope that, based on our research findings, and in conjunction with other studies that confirm the effectiveness of internet-based cognitive behavior therapy programs, digital mental health options such as Waypoint’s Thrive will be adopted by employers and health care systems, and that health insurers will provide reimbursement,” Schure says.

The Thrive for Montana research project is a collaboration between MSU and Waypoint Health Innovations. The MSU-led research project is not affiliated with the nonprofit, Bozeman, Mont.-based, social service corporation named Thrive.

More information about Thrive by Waypoint Health Innovations is available at bit.ly/msuthrive.

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