Montana State University was in town last week, promoting the second phase of a mental-health outreach program designed to help adults coping with depression and anxiety through an online, computer-based counseling program.
Mark Schure, Ph.D., an assistant professor of community health who works with the MSU Center for Mental Health Research and Recovery, did two presentations in Choteau on Sept. 18, one at the Choteau-Teton Public Library and one at the Stage Stop Inn, reaching about 30 people.
Schure hopes to enroll 1,000 Montanans in the second phase of a randomized controlled trial of THRIVE, an interactive, computerized cognitive behavior therapy program (cCBT for short) that the Center for Mental Health Research and Recovery began working on two years ago in response to the dire situation with mental healthcare access in Montana.
“We Montanans are in an epic mental health crisis in our state,” Schure said. “We have the highest suicide rate of any state in the country.”
Not only does Montana rank at the top for suicide rates, but it also ranks low among other states for mental health care access. MSU says 10 of the state’s 56 counties are classified as rural and 45 as frontier, highlighting the challenges of distance and provider availability.
Why is Montana’s situation so dire? The answers are complicated, Schure said, and involve intergenerational poverty and trauma; uncertainty in lifestyle, jobs and social services; the “cowboy up” mentality; discrimination toward people with mental health issues; and loneliness and other factors.
MSU founded the Center for Mental Health Research and Recovery to start addressing Montana’s unique mental health challenges, working with partners including MSU Extension and the state Legislature.
The THRIVE program is one of several that the Center is investigating to see whether it will help decrease depressive and anxiety symptoms and suicidal thoughts in Montanan adults.
THRIVE is an internet-based cognitive behavior therapy program — one that uses computer algorithms to generate an individualized response from a psychiatrist who helps people identify ways to improve their mood. The THRIVE modules can be accessed on a person’s computer, tablet or smart phone.
In other places in the United States, Schure’s literature said, THRIVE has been shown to decrease depressive and anxiety symptoms and improve people’s quality of life. In this phase of the study, participants will anonymously use the program for a year as often as they like, whenever they desire.
Schure said people eligible to participate must be: residents of Montana; 18 or older; have regular access to broadband internet service; have depressive symptoms that are at least mild; and not have participated in a previous THRIVE trial.
Schure said those interested in enrolling in the trial can do so starting in mid-October and running to May 2019 through the URL https://thriveformontana.com. This website will provide more information about the study, determine whether a person is eligible, and enroll eligible people in the study.
Those who are enrolled will be automatically randomized to receive the THRIVE program immediately or to receive the THRIVE program eight weeks after enrolling.
Participants will be asked to complete online questionnaires at different intervals. Each of the assessments will take 10 to 15 minutes, and MSU will email the participant a $10 Amazon gift voucher each time the person completes an assessment.
MSU will keep each participant’s personal information confidential and people already under the care of a mental health provider and/or on medications can continue to receive that care as well.
The first phase of the THRIVE trial in 2017 enrolled 350 participants, of whom about 15 percent were men and 85 percent were women.
Schure said the short-term results of the first phase show that THRIVE enrollees demonstrated marked improvement in depression and anxiety, improved work and social adjustment and resilience.
Further, he said, the improvement in the THRIVE subjects far outperformed anything in published drug trials for anxiety and depression.
“It is not a replacement for traditional treatment or therapy,” Schure said, but MSU believes it is a program that can be done in conjunction with other treatments or can fill a need for those who are unable to obtain other mental-health services.
THRIVE is also not designed to treat serious mental illnesses such as schizophrenia or bipolar disease. Cognitive behavior therapy focuses on changing a person’s thought patterns and behaviors with the goal that their feelings will also change, Schure said, adding that CBT techniques are based on 40 years of research.
THRIVE uses three CBT techniques, teaching people to re-engage with their hobbies, exercise and other people; how to recognize and stop negative thought patterns; and how to communicate clearly and confidently so they have more meaningful and positive interactions with people every day.
The THRIVE program has 300-plus different videos and 100-plus interactive elements and algorithms, Schure said, and through this trial people are being offered the program free of charge. The cost per person is $120 to $140 for one year, compared to the same cost for one counseling session with a mental healthcare provider.
During the first phase of the THRIVE trial, Schure said, MSU held two focus groups, one of which was in Choteau. People here thought the videos were too urban in nature, so the Center for Mental Health Research and Recovery partnered with the MSU Film Department, using grant funding, and filmed Montana-based videos to replace 10 of the existing THRIVE videos.
The people in Choteau who attended Schure’s evening program at the Stage Stop Inn said they believe there is a need for mental healthcare access all across the state.
Some of those attending were with the USDA Farm Service Agency state meeting being held at the Stage Stop Inn. Several of those said they work with a lot of farmers and ranchers who are struggling with depression and anxiety.
Several others said they personally are coping with diagnoses of depression and anxiety and were looking for help that they could receive in their own homes and on their own schedules rather than having to carve three or more hours out of their working days to travel to Great Falls to see a provider.
Schure said that if the evidence-based results continue to show that the THRIVE program works well for anxiety and depression, MSU will try to join with large employers, state government, healthcare systems and more to make the program available across the state. He said he also hopes that insurance companies will at that point begin to reimburse costs for individuals to take the program.
In addition to Schure, the MSU team working on THRIVE includes Sandra Bailey, a professor of family and human development with MSU Extension; and THRIVE co-creator Dr. John Greist, a professor of psychiatry-emeritus at the University of Wisconsin-Madison and an affiliate professor of cell biology and neuroscience at MSU.
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