Good Days Ahead uses interactive exercises, audio, and videos based in cognitive therapy principles to improve depression symptoms.
The Good Days Ahead program has six modules that focus on changing automatic thoughts, taking action, changing schemas, and continuing progress after program completion. All modules contain audio guidance from clinicians, videos of individuals using cognitive therapy skills to cope, interactive exercises, and multiple choice review questions. Videos include actors of both genders and multiple ethnicities. Sessions are 20-45 minutes in length and the program can be completed in eight sessions.
Link to commercial site: https://mindstreet.com/
Young Adults (18-30)
Mental health clinic
Computer-assisted cognitive therapy for depression: Maintaining efficacy while reducing therapist time.
Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, Otto MW. American Journal of Psychiatry. 2005. 162(6): 1158-1164. doi: 10.1176/appi.ajp.162.6.1158
Summary: The authors conducted a randomized controlled trial to test the efficacy of Good Days Ahead for individuals with depression. Participants with current depression (n=45) were recruited by advertisement or referral to the study. Individuals were excluded from the study if they were prescribed psychoactive medications for depression. All participants were randomized to either standard cognitive therapy only, standard cognitive therapy plus computer-assisted cognitive therapy, or a wait-list control. While the waitlist control group received no treatment, participants randomized to standard cognitive therapy received nine in-person sessions with a therapist, and those assigned to the computer-assisted group received the nine in-person sessions followed by eight sessions of the Good Days Ahead computer program. Depressive symptoms were measured pre-treatment, and at 1-, 2-, 3-, and 6-month follow-ups. At all follow-up assessments, results showed that participants getting either standard cognitive therapy or the additional computer-assisted cognitive therapy had significantly larger decreases in depressive symptoms than participants in the waitlist control. These reductions were maintained even at the 6-month follow-up. At the 2-month follow-up, participants in the computer-assisted group had greater improvements in dysfunctional attitudes and cognitive distortions, when compared to the waitlist control.
Take Away: Although adding Good Days Ahead to standard therapy does not result in further decreases in depressive symptoms, Good Days Ahead may impart additional benefits for users with depression by further decreasing cognitive distortions and dysfunctional attitudes.
Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder
Kim DR, Hantsoo L, Thase ME, Sammel M, Epperson N. Journal of Women’s Health. 2014. 23(10): 842-848. doi: 10.1089/jwh.2014.4867
Summary: Researchers recruited 12 pregnant women with major depression from a women’s behavioral wellness center using advertisements and referrals. Participants received 8 sessions of clinician-assisted Good Days Ahead (GDA) for 2 months. Each session included time with a clinician and time to work on a GDA session. Time with the clinician was spent reviewing experiences with GDA, skill use in the past week, and plans for upcoming sessions. Participants completed assessments of depression symptoms, attitudes towards and expectations of treatment, anxiety symptoms, postpartum depression, overall functioning, quality of life, and interpersonal problems at baseline, and 1, 2, and 5 months post-intervention. Participants also kept a treatment diary to track session completion, medication adherence, treatment satisfaction, and willingness to try computerized CBT. Of the 12 women who were recruited and initiated treatment, 10 completed treatment, and 8 completed the follow-up assessment. Participants experienced significant improvements in depression severity, anxiety, postpartum depression, functioning, quality of life, and interpersonal problems between baseline and 2 months post-intervention. Among participants who completed treatment, 80% experienced treatment response (i.e. 50% decrease in depression severity) and 60% experienced remission from depression (i.e. Hamilton Depression Rating Scale score or 10 or below). Four participants were in remission from depression at 3-months follow-up.
Take Away: Completion of clinician-assisted GDA may promote clinically significant improvements in depression in pregnant women.
Improving the efficiency of psychotherapy for depression: Computer-assisted versus standard CBT
Thase ME, Wright JH, Eells TD, et al. American Journal of Psychiatry. 2017. 175(3): 242-250. doi: appi.ajp.2017.17010089
Summary: Researchers used advertisements and clinician referrals from 2 university clinics to recruit 154 patients with major depression who were not currently taking psychotropic medication. Participants were randomly assigned to receive GDA for 4 months or an intensive regimen of Cognitive Behavioral Therapy (CBT), including 20 50-minute sessions attended twice weekly for 1 month and weekly for 3 months. Participants completed assessments at baseline, 1, 2, 3, 4 (post-treatment), 7, and 10 months. Participants completed assessments of depression (baseline, 1, 2, 3, 4, 7, and 10 months), maladaptive cognitions (baseline, 2, 4, 7, and 10 months), interpersonal functioning, global functioning, and knowledge about CBT (all 3: baseline, 4, 7, and 10 months). Both groups experienced similar reductions in depression symptom severity between baseline and 16 weeks, which were maintained at 7 and 10 months post intervention. Rates of treatment completion (GDA: 81.8, CBT: 79.2%) were similar between groups. Participants who received GDA reported significantly higher CBT knowledge than the CBT group at 4, 7, and 10 months.
Take Away: Good Days Ahead shows evidence of comparable effectiveness to an intensive CBT regimen for improving depression symptom severity and indicators of functioning for up to 6 months post-treatment.
Computer-assisted cognitive behavioral therapy to prevent relapse following electroconvulsive therapy
Wilkinson ST, Ostroff RB, Sanacora G. Journal of Electroconvulsive Therapy. 2017. 33(1): 52-57. doi: 10.1097/YCT.0000000000000348
Summary: Researchers recruited 15 patients with major depression who had achieved response or remission after receiving electroconvulsive therapy (ECT) to evaluate the potential for GDA to prevent relapse following ECT. Courses of ECT began with three ECT appointments weekly, with patients gradually decreasing the frequency of appointments. When patients were receiving ECT on a weekly basis or less, they were enrolled in GDA. Participants were asked to complete at least 1 GDA lesson per week, but could complete sessions at their own pace for up to 6 months. During the first 2 months of combined treatment, participants received weekly calls to support GDA. Participants completed assessments of depression symptoms weekly for the first month of treatment and monthly thereafter. Researchers also recorded the number of GDA lessons completed and time spent using GDA. Participants completed 84% of lessons on average (7.6/9) and spent 8.4 hours on average using GDA. Most participants (n=10) reported lower or equivalent depression severity by the end of GDA. Five participants had achieved remission after the initial intensive course of ECT (3 times weekly), all of whom retained remission by 6 months and 1 additional participant achieved remission by study end. Five participants relapsed over the course of the study. Participants who relapsed completed significantly fewer lessons than participants who did not relapse.
Take Away: GDA is feasible for depressed patients to complete on their own and shows preliminary evidence of preventing relapse of depression symptoms following ECT.