An in-depth look at digital cognitive behavioural therapy

Cognitive behavioural therapy is one field of mental-health treatment that’s moving progressively towards being digitally delivered.

This is because digital CBT provides greater access to treatment, specifically for those in remote areas, and also helps to control costs, said Jennifer Wild, a consultant clinical psychologist and associate professor at the University of Oxford in England.

Speaking at a session at Benefits Canada’s 2018 Mental Health Summit Toronto on Nov. 12, Wild noted while digital CBT reduces the time a therapist spends treating a person, it doesn’t necessarily reduce the patient’s time in treatment because they have homework tasks outside of the face-to-face contact with the therapist. “But what it does do, which is really key, is reduce the therapist contact time,” she said.

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Wild outlined the four types of digital CBT: completely standalone treatment without therapist or non-clinical coach support; smart standalone, which responds to user input and then tailors the treatments; coach supported treatment, such as apps aimed at treating generalized anxiety disorder and depression; and therapist-supported treatment.

Evidence shows social anxiety responds better to supported treatment, while the standalone option may be sufficient for insomnia and post-traumatic stress disorder, said Wild, noting depression shows some short-term gains with digital CBT.

Since co-morbidity — or more than one disorder at the same time — is very common, many mental-health disorders share the same processes, included avoidance, suppression, dwelling and self-focused attention, she explained. So an option here is transdiagnostic CBT.

“What transdiagnostic CBT is saying is rather than treat one of these disorders, and maybe hope the other ones will resolve or treat all three of them in sequence, what we’ll do is just treat the common processes across and we’ll offer a very parsimonious and efficient approach to helping somebody get well,” said Wild.

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It does show some success, she noted. “It’s as effective as the disorder-specific treatments in reducing anxiety and it seems to be more effective at reducing depression — a pretty difficult disorder to treat.”

However, the key factor in this style of treatment lies in prevention, said Wild. “This is a really exciting finding. What we’re finding is, if we can help people who are at risk of developing depression because they’re likely to dwell and ruminate about past events, if we can teach them what dwelling is and how to change it, we can prevent an episode of depression. That is really exciting and that keeps people well, right from the start, because it means they never get on that trajectory of a depressive episode and have to take time off work.

“Transdiagnostic CBT is really something to keep your eye out for,” she added.

Wild also noted a key next step is to identify what works for each patient. “Some people are going to get great recovery with standalone and some people are going to require a bit more support.”

Read more coverage from the 2018 Mental Health Summit.