Limited access to therapists, cost and stigma around mental health can make it difficult for rural Montanans to get the care they need. Now, Bozeman researchers are testing and adapting a new online program that’s been shown to side-step those barriers and reduce depression and anxiety for adults.
Bill Bryan says people living in rural parts of the state face extra hurdles to getting mental health support compared to their urban counterparts.
Bryan is the co-founder of the non-profit organization One Montana, which seeks to bridge gaps between urban and rural Montana.
“If you live in Circle, Montana and you want to see a therapist and you have to go to Billings, you know, that’s a long drive -- four hours or plus, five hours or so -- and then you’re supposed to go back in a month,” Bryan said.
On top of paying for gas and perhaps taking unpaid time off from work is the cost of seeing a therapist, which is generally over $100 an hour without insurance coverage.
Bryan says another issue more prevalent in rural parts of the state is the stigma around mental health and the lack of privacy in a small, tight-knit community.
“If there was a therapist and I parked my pickup in front of his or her office, everyone knows that’s my pickup and ‘Old Bill’ is in there,” Bryan said.
Several years ago, Bryan started working with people at Montana State University to see if a new online program called Thrive could be adjusted for rural Montanans and improve access to mental healthcare.
So far the results have been encouraging, according to Mark Schure, an assistant professor of community health at MSU.
Schure studied Thrive’s effectiveness at reducing symptoms of depression and anxiety for nearly 350 adults across Montana. His results were published in the Journal of Medical Internet Research in November.
Participants in the study reported significant reductions in symptoms of depression and moderately positive effects on anxiety after eight weeks with the program.
The study found users were also 45 percent less likely than the control group to experience increased suicidal thoughts.
Some of the participants in the study said a lack of internet connectivity was an issue but Schure says that will become less of a barrier as better satellite technology moves onto the market.
Schure says Thrive shouldn’t replace therapists, especially if someone is severely depressed and having suicidal thoughts. But he says it’s effective at preventing something from turning into a crisis and helping people who don’t have access to mental health services.
So, how does it work?
Thrive starts with a series of questions.
Based on how you respond, the program gives you a score and walks you through a series of tailored videos. Some of them play out as testimonials from people going through something similar. They provide validation and certain therapeutic techniques to practice in real life.
Unlike Telehealth, there isn’t a live person on the other end. It’s all automated and algorithm-based.
Schure and other people at MSU have been working to tailor the program, which was developed by a Seattle-based tech company, to feel more relatable to people living in Montana.
“What we found when we first started this project is that a lot of the videos were just too urban, a lot of the people and settings just didn’t make sense for Montana in general. So we took the time and money to replace a lot of those example videos,” Schure said.
One of those new videos features Jason, a married 32-year-old veteran who raises cattle and pheasants and grows seed potatoes. The story is based on a real person’s experience but has been tweaked to protect his privacy.
"You hear about guys going through a crisis, buying a new pick-up truck. For me, I just ran out of energy. Everything felt like a chore, even things I used to enjoy,” Jason says in the video.
Further into the video, Jason talks about seeing a doctor because he thought there was something physically wrong with him. He says the doctor suggested doing a rewarding or enjoyable activity every day, even if he didn’t feel like it. Jason started making time to fish and hunt again.
“I only made it twice that first week but it gradually became a habit and it became a new way to tackle my days. My sleep improved and I felt more energetic,” He said.
Schure says Thrive is based on an approach called cognitive behavior therapy.
“Basically it works on the central premises that our feelings and our thoughts both affect our behaviors, and our behaviors in turn also affect how we feel,” Schure said.
The video about Jason highlights one of Thrive’s focus areas: Identifying and making time for activities that can boost a person’s mood.
Other focus areas in the program include tackling negative thinking patterns, or constant thoughts like ‘I’m worthless’ or ‘I fail at everything,’ and building effective communication skills with friends, family and colleagues.
MSU’s Mark Schure says this year his team will be looking at the long-term effects of Thrive and replicate the study with a larger sample of 1,000 adults.
Researchers will also be developing a version of Thrive for youth in the state with a pilot project expected to be ready for the fall.