The Research Behind C-CBT
The practice of computer-assisted therapy, particularly computer-assisted cognitive-behavior therapy (C-CBT), typically provides a software component in conjunction with talk therapy. This field has shown promising results in lowering therapist resource requirements while matching patient improvement and engagement with traditional talk therapy.
What is Cognitive-Behavior Therapy (CBT)?
Developed by Dr. Aaron Beck, cognitive-behavior therapy (CBT) is a form of psychotherapy based on the cognitive model, which stipulates that the way we perceive situations influences how we feel emotionally. CBT is one of the few forms of psychotherapy that has been rigorously scientifically tested (in over 400 clinical trials) and found to be effective across the behavioral disorder spectrum. Dr. Beck is also a co-author of Empower’s flagship module for anxiety and depression, Good Days Ahead.
At each CBT session, clinicians help their patients identifying specific events or situations that occurred which may have triggered certain ideas or thoughts that interfere with the individual’s ability to solve problems. Data is collected to help the individual identify correlations between these events, the ensuing thoughts and the resulting emotions. Using this information, the clinician and individual together create an action plan for the individual to start implementing solutions to their problems so that the individual can begin to use the skills and tools learned in their day-to-day lives.
To learn more about CBT, we recommend visiting the Beck Institute website.
The rapid pace of technological development has enabled therapists to incorporate computer and technological strategies into their CBT practices.
What is Computer-Assisted CBT (CCBT)?
Computer-assisted CBT (C-CBT) is a form of CBT that utilizes a digital program to deliver a significant part of the therapy component or uses a digital program to assist the work of a therapist. This includes any digital technologies including videos, interactive exercises or mobile applications.
It is important to note that C-CBT is not meant to replace therapists or talk therapy. Clinician involvement includes at least screening, supervision, and support of computer program use, and may involve an integrated human-computer “team” approach to treatment. Published studies have demonstrated acceptance of C-CBT by patients and clinicians and its efficacy as compared to traditional talk therapy.
In a 2002 study conducted by Empower co-founder Dr. Wright, C-CBT and CBT were rated for acceptance by both patients and therapists using 1-5 point affinity scales. Based on drop-out rates, affinity scores, and primary outcome measures, C-CBT was demonstrated to be an acceptable treatment method and no better or worse than standard CBT delivered completely by the therapist.
A key randomized controlled trial was conducted using a DVD-ROM version of Good Days Ahead (Wright et al., 2005). The study compared 45 drug-free patients clinically diagnosed with depression assigned to CBT (traditional CBT talk therapy, 9 sessions in 8 weeks); CCBT (initial session of 50 minutes, eight sessions of 25 minutes, and eight 25-minute computer sessions); and a wait list control group.
The durability of treatment gains was also assessed with follow-up ratings 3 and 6 months post-treatment. Results indicated that both C-CBT and CBT appeared to have lasting effects over this time period.
Dropout rates were similar for all three groups of patients (2 each for C-CBT and CBT and 1 for the wait list). There were no significant differences found in the primary outcome measures (HAMD and BDI-II) between C-CBT and CBT. Both treatments were significantly better than the wait list in reducing symptoms of depression.
Other interesting findings included that C-CBT proved superior to the wait list in improving dysfunctional attitudes, but traditional CBT did not outperform the wait list in this regard. In addition, C-CBT was more effective than CBT and the wait list in improving knowledge of CBT (as measured by the Cognitive Therapy Awareness Scale – CTAS).
More recently, Dr. Wright and colleagues completed an NIH-funded, multi-site study comparing “gold standard” cognitive-behavior talk therapy (16.6 hours) with computer-assisted CBT with just one-third of the therapist time (5.5 hours). With over 150 patients participating between the two sites (University of Louisville and University of Pennsylvania), both groups saw significant and equivalent reduction of depression scores as well as 84% completion rates. In addition, strong pre-post effect sizes were observed for both CBT (2.0) and CCBT (2.4).
For full details on these studies, please review the links below.