A qualitative study of digital CBT for veteran depression: Treatment experiences and recommendations for healthcare system integration.

Depression affects over one-third of US military veterans, yet substantial barriers impede access to evidence-based psychotherapy. Internet-delivered cognitive behavioral therapy (iCBT) offers promise for addressing treatment gaps, but no research has examined veteran experiences with fully self-guided digital interventions. This qualitative study explored how veterans with depressive symptoms engaged with Deprexis, a self-guided iCBT program, to inform strategic implementation within Veterans Health Administration (VHA) care systems. Semi-structured interviews were conducted with 18 veterans (mean age 55.2 years, 44% female) who completed on average 7 of 10 iCBT program modules. Reflexive thematic analysis identified patterns across five domains: treatment motivation, therapeutic mechanisms, digital format features, engagement barriers, and implementation recommendations. Veterans valued treatment autonomy, privacy, and accessibility while identifying cognitive decentering and behavioral activation as key therapeutic mechanisms. However, participants articulated a fundamental paradox: iCBT requires self-initiated engagement precisely when depression most impairs motivation. Veterans recommended a stepped-care framework matching intervention intensity to symptom severity, with primary care as the optimal entry point for mild-to-moderate presentations. For moderate severity, veterans suggested minimal external support structures including care coordinator check-ins rather than intensive therapist contact, preserving the resource efficiency enabling scalability. Veterans positioned digital CBT as serving multiple strategic functions within VHA infrastructure: standalone treatment when appropriate, bridge intervention during specialty care waitlists, treatment motivator, or therapy adjunct. Findings provide actionable guidance for deploying evidence-based digital interventions within resource-constrained systems as precision tools addressing specific treatment gaps while preserving intensive services for complex presentations.
Mental Health
Access
Care/Management

Authors

Pearson Pearson, Mignogna Mignogna, Metts Metts, Beevers Beevers, Post Post, Creech Creech
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