Computerized Therapy: The New Therapists?

With the question of how to pay for good psychotherapy (nevermind how to find or get “good” psychotherapy in the first place) not far from many people’s minds, researchers are spending more time looking at alternatives to traditional but expensive face-to-face psychotherapy. While some therapists are exploring alternative realities, researchers are still focused on far more accessible, some might even say “mundane,” approaches.

CBT4CBT is one such approach. It stands for computer-based training (CBT) for cognitive-behavioral therapy (CBT) (get it?). It basically teaches the components of cognitive behavioral therapy sans therapist using an approach “based on elementary-level computer learning games, and the presentation of material was done in a range of formats, including graphic illustrations, videotaped examples, verbal instructions, audio voiceovers, interactive assessments, and practice exercises.” In other words, the researchers tried to make it engaging and interactive, and not too dry — a failing of previous attempts to make CBT interesting via computer.

In this particular study, the researchers wanted to assess its effectiveness in the treatment of cocaine addiction. So it consisted of six lessons, or modules, using content based closely on a CBT manual published by the National Institute on Drug Abuse. The researchers wanted to use this manual (which anyone can read, download and use on their own) because it had been used in several previous randomized, controlled trials in a range of substance-using populations. This makes the results more comparable across studies.

According to the researchers, the modules covered the following core concepts: 1) understanding and changing patterns of substance use, 2) coping with craving, 3) refusing offers of drugs and alcohol, 4) problem-solving skills, 5) identifying and changing thoughts about drugs and alcohol, and 6) improving decision-making skills.

Although the treatment numbers were relatively small (N = 48, 22 in CBT4CBT, the rest in treatment as usual group), the researchers did find the people who took the computer-based training program produced half as many positive urine specimens at follow-up. They did not find a significant difference between periods of abstinence between the two groups (although there was a slightly longer period for those who were in the CBT4CBT group).

There’s still a ways to go. Subjects in the CBT4CBT group on average completed only 4 of the 6 sessions, and session length averaged 38 minutes (compared to the expected length of 45 minutes, suggesting either the initial estimate was off or some patients “rushed through” the exercise). Treatment attrition rates with substance abuse users is usually fairly high, so some of this can be accounted for because of the population being treated.

The good news is that as these CBT programs become more interactive and engaging, as this one was, the costs of delivering treatment to individuals can approach zero. Zero? Yes, zero. The costs of offering these programs can be defrayed through sites like Psych Central and other organizations offering the programs for free (and picking up the tab of the costs themselves). We will gladly offer such programs here once they become more widely available online.

Will these programs replace face-to-face psychotherapy any time soon? No, of course not. They are just one more modality of possible help that people can use, just as as there are dozens of other modalities, such as self-help books, support groups , e-therapy, and more.

And with more and more of these modalities becoming available, we hope the cost of treatment decreases, opening it up to more and more people.

Read the editorial on the study: A Promising Debut for Computerized Therapies
Read the study itself (click on the “Full Text” link on the article page): Computer-assisted delivery of cognitive-behaviorial therapy for addiction: a randomized trial of CBT4CBT

Reference

Carroll, K.M. et al. (2008). Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT. Am J Psychiatry, 165, 881-888.