TY - JOUR
AU - R. Pearson
AU - J. Mignogna
AU - A. Metts
AU - C. G. Beevers
AU - E. P. Post
AU - S. K. Creech
A1 - 
AB - 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.
AD - VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive, Waco, TX 76711, United States. Electronic address: rahel.pearson@va.gov.; Rocky Mountain MIRECC, Rocky Mountain VA, Aurora, CO, United States.; VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive, Waco, TX 76711, United States.; Department of Psychology and Institute for Mental Health Research, University of Texas, Austin, TX, United States.; Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, United States; Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.; VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive, Waco, TX 76711, United States; Department of Psychiatry and Behavioral Sciences, Dell Medical School of the University of Texas, Austin, TX, United States.
AN - 42066479
BT - Psychiatry Res
C5 - HIT & Telehealth; Healthcare Disparities
DA - 08/2026
DO - 10.1016/j.psychres.2026.117176
DP - NLM
ET - 20260418
JF - Psychiatry Res
LA - eng
N2 - 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.
PY - 2026
SN - 0165-1781
SP - 117176
ST - A qualitative study of digital CBT for veteran depression: Treatment experiences and recommendations for healthcare system integration
T1 - A qualitative study of digital CBT for veteran depression: Treatment experiences and recommendations for healthcare system integration
T2 - Psychiatry Res
TI - A qualitative study of digital CBT for veteran depression: Treatment experiences and recommendations for healthcare system integration
U1 - HIT & Telehealth; Healthcare Disparities
U3 - 10.1016/j.psychres.2026.117176
VL - 362
VO - 0165-1781
Y1 - 2026
ER -