After extensively analyzing more than 50 articles and systematic reviews of cognitive behavioural therapy, Deborah McLeod, director at Carepath Inc., knows there are still questions to be explored.
While it’s generally acknowledged that facilitated interventions are better than non-facilitated, there’s evidence that standalone methods work as well, said McLeod during a session at Benefits Canada’s 2018 Mental Health Summit Toronto on Nov. 12. “What’s not clear in the literature yet is how much facilitation is enough.”
Research conducted by McLeod and a colleague found a successful CBT program is module-based, with six to eight modules; is technically sound and engaging if it’s delivered via the Internet or an app; and is typically facilitated.
Another concern around online therapy programs, noted McLeod, is how therapeutic alliance, or the bond and goals between a therapist and a patient, may be affected. “There was a lot of fear early on that these distance modalities would decrease the therapeutic alliance, and thereby decrease the effectiveness of the intervention. From the literature we’re seeing, that’s not the case,” she said.
But not everyone is a good candidate for virtual mental-health care, added McLeod, noting severely distressed people are likely to need assessment and planning. As well, suicidal patients aren’t suitable candidates for standalone treatment.
Generally, those who are most likely to participate in digital therapy are older, female, more educated, have low personal stigma and sometimes have higher depressive symptoms, said McLeod. But many therapy programs have identified several ethical dilemmas, such as managing privacy and emergencies and ensuring quality assurance.
“Quality assurance can be a problem,” she said. “How do you know programs are sound, especially if you’re not a mental-health provider? This is a dilemma in Canada because there are a huge number of programs available and not necessarily a lot of guidance . . . there’s a lot of fragmentation.”
Access is another consideration around digital therapy, said McLeod. “We have to be aware that not everyone has electronic access, despite the fact that large numbers of people do. And because digital interventions may be helpful for governments that want to improve the mental health of their populations, they’re cheaper, there’s going to be an inclination to jump on that bandwagon and there’s going to be a potential that people will not have access to service.”
Read more coverage from the 2018 Mental Health Summit.