Despite Effectiveness, Computerized Cognitive-Behavioral Therapy Slow to Catch on in United States

Numerous studies have shown that guided computerized cognitive-behavioral therapy (CCBT) is as effective as face-to-face therapy at treating anxiety and depression.

Michael E. Thase, M.D., a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania, conducted his own study on CCBT in which cognitive therapists spent about five hours coaching, guiding, and supporting patients who used the Good Days Ahead CCBT site. Good Days Ahead is also being used by the U.S. military.

Thase and his colleagues compared them with patients who received about 20 hours of traditional, in-person CBT over 16 weeks, according to the study, which was published in the American Journal of Psychiatry in October 2017.

The good news, he said, was that patients using CCBT did as well as those participating in conventional CBT. Both groups had a robust 45 percent remission rate and an 80 percent completion rate, Thase said.

Despite these results, Thase said he does not see CCBT as a replacement for therapy, but rather a way for clinicians to reach three times as many patients in need of help. “I don’t think clinicians are at any risk of putting themselves out of business,” Thase said. “I think [CCBT] can complement, extend, and make more available conventional cognitive-behavioral therapy. I see it as a real, practical way to extend and enhance what we know how to do.”

Still, while such programs have taken off in Europe and Australia, they have been slower to catch on in the United States.

“We know that delays in implementation of evidenced-based interventions are common,” said Kathleen M. Griffiths, Ph.D., a professor of psychology at the Australian National University and creator of the CCBT web site The Mood Gym. “In the past, it has taken 17 years on average to translate research into clinical practice. The delivery of treatment via the internet provides an unprecedented opportunity to reduce this lag.”

The question for psychiatrists is how can they integrate CCBTs into their practice? One suggestion from Bruce L. Rollman, M.D., of the University of Pittsburgh School of Medicine is that patients “need a little bit of a human touch” to get them to start and stick with an online program. “You can’t just give people a link and say ‘Here, do it on your own.’ That’s not going to work.”

For psychiatrists, such encouragement could easily occur during medication checks, Rollman suggested. ■