Montana ranks high among states on mental health disorder prevalence and low on access to mental health care.  It has the highest suicide rate in the nation.  Of Montana’s 56 counties, 10 are classified as rural and 45 as frontier, accentuating distance and provider availability challenges in accessing care.  New treatment delivery modalities are needed to complement, supplement and augment scarce mental health care.  With increased Internet accessibility, computer-administered Cognitive Behavior Therapy (cCBT) programs have emerged as viable approaches to effective treatment of depression.  Thrive, a sophisticated interactive digital cCBT program using a largely video format platform intended to enhance engagement, has been shown to significantly reduce depressive symptoms among adults with varying severity of depressive symptomatology in uncontrolled trials in urban settings.

The goal of this project is to conduct a randomized controlled trial (RCT) of Thrive to determine its effectiveness in reducing depressive symptom severity among Montanans, many of whom have few or no other options for mental health treatment.   During Year 1, we conducted focus groups with community members and key informant interviews with community leaders to understand the acceptability of and ways to effectively promote Thrive in Montana communities. Findings from the interviews and focus groups indicate: 1) mental disorder symptom distress is both prevalent and stigmatized in rural communities, 2) mental health care access is limited to non-existent in these communities, 3) community members view the Thrive program as a viable option for many people with specific benefits of accessibility and confidentiality, and 4) given the existing stigma, it would be beneficial to promote Thrive and recruit persons for the RCT using tailored methods. This project is expected to have an immediate positive impact on Montanans with depressive symptoms, syndromes, and disorders. The long-term goal of this project is to provide a culturally acceptable, accessible, engaging, and confidential evidence-based tool to treat depressive symptoms, syndromes and disorders and improve the health and quality of life for Montanans and other rural populations.

Specific Aims

This project is expected to have an immediate positive impact on some Montanans suffering depression.  The ultimate aims are to produce gold-standard evidence on the efficacy ofThrive, a cCBT program to treat depression in rural and frontier settings and more broadly, the potential value of interactive digital health interventions. These goals will be accomplished by addressing the following three aims:

  1. Produce a cultural adaptation of Thrive in collaboration with the MSU College of Film and Photography
  2. Implement a community-based randomized controlled trial (RCT) of the culturally-adapted version of Thrive using innovative strategies for effective recruitment and retention of study participants and convenient delivery and completion of online assessments
  3. Conduct analyses to determine the effectiveness of Thrive to treat depressive symptoms, syndromes and disorders for Montanans

Primary Contact

Mark Schure mark.schure@montana.edu


Sandra Bailey (MSU), Matt Byerly (MSU) and John Greist (University of Wisconsin-Madison)