Cognitive-behavioral therapy delivered via computer-based training appears
to be a successful adjunct to treatment of substance use disorders, according
to a report in the June American Journal of Psychiatry.
Patients receiving biweekly access to computer-based training in
cognitive-behavioral therapy (CBT4CBT) skills in addition to standard
treatment submitted significantly more urine specimens that were negative for
any type of drugs than did patients who did not receive CBT4CBT. There was
also a trend toward longer continuous periods of abstinence.
Moreover, outcome was more strongly associated with treatment engagement
among the CBT4CBT patients, as demonstrated by the fact that completion of
homework assignments in CBT4CBT was significantly correlated with outcome and
was a significant predictor of treatment involvement.
"This study points to a means of delivering this form of CBT much
more broadly and inexpensively, and with improved consistency, potentially
24/7 with remote access," lead author kathleen Carroll, Ph.D., told
Psychiatric News. "Moreover, it can address the shortage of
clinicians trained in CBT and can free up clinician time, and possibly even
encourage more substance users to seek treatment.
"And because of the level of standardization afforded by
computer-assisted delivery, we think it can encourage higher levels of skills
acquisition as well as our researchers' ability to evaluate CBT's mechanisms
with a higher level of precision." Finally, she noted, this method
allows therapists to tailor CBT to patients' needs and progress, allowing them
to move at their own speed.
She is a professor of psychiatry in the division of substance abuse at Yale
University School of Medicine.
In the study, 77 individuals seeking treatment for substance dependence at
an outpatient community setting were randomly assigned to standard treatment
or standard treatment with biweekly access to CBT4CBT.
CBT4CBT consisted of six lessons, or modules, covering the following core
concepts: understanding and changing patterns of substance use, coping with
craving, refusing offers of drugs and alcohol, problem-solving skills,
identifying and changing thoughts about drugs and alcohol, and improving
The concepts were depicted in "movies" using actors and
realistic settings in which an individual is offered drugs or had to cope with
a challenging situation in which substance use was likely. Then the movie was
repeated with a different ending to demonstrate the use of skills required to
change the outcome.
Next, each module included an interactive assessment followed by a short
vignette with an actor explaining how use of each skill had helped him or her
avoid substance use and how each CBT principle could be applied to other
problems. Finally, a narrator reviewed key points, and participants were given
a practice assignment.
Standard treatment or "treatment as usual"—which was also
available to those in the CBT4CBT group—consisted of weekly individual
and group sessions of general drug counseling. Patients in both groups also
met twice weekly with an independent clinical evaluator who collected urine
and breath specimens, assessed recent substance use, and monitored other
The participants assigned to CBT4CBT submitted significantly fewer urine
specimens that were positive for any drug and a lower proportion of urines
that were positive for any drug. This was most marked for cocaine (28 percent
for patients in the CBT4CBT group versus 44 percent for those in the
Patients in the CBT4CBT group had an average of 22 days of continuous
urine-confirmed abstinence during treatment compared with 15 days for those in
the treatment-as-usual group, a difference that fell just short of statistical
The investigators also found that outcome in the CBT4CBR was strongly
related to treatment adherence—indicated by the number of days retained
in the treatment program, the number of individual, and group sessions
attended, and homework completion—suggesting that the computer-based
training was an integral part of the success of the treatment.
In contrast, in the treatment-as-usual group, outcome was more strongly
related to the severity of substance abuse at baseline.
"Given the link between use of the program and outcome, more frequent
access to and use of the CBT4CBT program... should be evaluated as a strategy
to enhance the potential benefits of this approach," the authors
"Computer-Assisted Delivery of Cognitive-Behavioral Therapy
for Addiction: A Randomized Trial of CBT4CBT" is posted at<http://ajp.psychiatryonline.org/>.▪