As the demand for mental health services increases (1 in 5 Americans need help at some point), providers are seeking new ways to assist the greatest number of people in the most efficient manner. More often, they're turning to online and telehealth therapy options.

Cognitive Behavioral Therapy (CBT) is among the most researched and effective approaches used in counseling and psychotherapy. This method focuses on examining and modifying one's inner self-talk, which, when it proves negative, catalyzes emotional states and behaviors that undermine well-being. Often used to treat depression, anxiety, stress, eating disorders, post-traumatic stress disorder (PTSD) and related mental challenges, CBT actively engages patients in addressing these issues by learning new ways of thinking, feeling and behaving that promote improved self-care and mental wellness. What's more, CBT has been used to assist individuals with the psychological impacts of chronic medical conditions such as diabetes, pain, heart disease and other health challenges.

Until the advent of the internet and mobile devices, CBT was provided almost entirely through face-to-face sessions. However, increasingly, mental health organizations are offering an online version of this approach called "computerized CBT," or cCBT for short. Like many consumer-driven online services, cCBT uses artificial intelligence or AI, and interactive algorithms to approximate some of the same back-and-forth exchanges one might expect in face-to-face counseling. In this sense, AI assumes the role of "therapist." Most cCBT programs involve a series of online sessions and interactive experiences conducted over a period of weeks. Frequently, the client is assigned specific "homework" to complete in between sessions. Some cCBT formats are entirely AI-driven, while others offer the user the option to interact with a live counselor when additional guidance is needed.

Why the need?

The impetus for this new platform stems from a varying array of needs.

The challenges facing those in rural communities in accessing counseling resources.
The increased preference among consumers of mental health services for immediate, 24/7 accessibly that provided maximum convenience and privacy.
Nearly 3 out of 4 in need of mental health therapy will not seek in-person therapy due to social stigmas or accessibility limitations.
The increased confidence, through studies and research, that cCBT is just as effective as in-office therapy.

Does it work?

Research into the effectiveness of cCBT is ongoing and far from complete. However, initial studies show considerable promise, and some demonstrate that its efficacy is similar or equal to that found with traditional CBT. A variety of delivery platforms are available and it will take time to clarify which yields the greatest benefits. What's more, research of this kind requires long-term studies that follow clients over many years to fully confirm longitudinal results.

However, while few studies have examined the impact of cCBT on measures of employee performance and well-being (e.g., absenteeism, productivity, mental health insurance claims, etc.), many researchers assert that improvements were seen in clients treated with this modality in clinical settings likely translate into the workplace. The expectation, then, is that improvements in depression, anxiety and stress-related disorders seen among cCBT users, in general, should show positive impacts on employee performance and well-being in specific.

What we do know is that cCBT, like its face-to-face version, is most effective in addressing the following types of unhealthy mental tendencies:

Negative Cognitive Bias: The subconscious habit of seeing only the negatives in one's life and few, if any, of the positives.
Overgeneralization: Assuming all happenings and people are the same, based entirely on one or a very few negative experiences.
Catastrophizing: Certainty that the worst-case scenario one is worrying about, will come to pass.
Fallacy of fairness: Believing the world should be fair and just, and that one can make it so by doing all the right things.
Blaming: Assigning responsibility for one's distress or unhappiness entirely to one's self, others or fate.
Shouldism: Applying a rigid set of beliefs and judgments to one's self, while also expecting others to conform to what one believes they should or should not do.
Perfectionism: Expecting one's self (or others) to never make mistakes and meet unrealistically high standards of behavior and performance.
Emotional certainty: Maintaining the belief that, "If I feel it, then it must be true."

In terms of specific challenges, cCBT has been studied most in relation to anxiety and depression, the two most common mental disturbances. Here, it has shown considerable promise in treating these conditions, at least among those with mild to moderate cases. Severe and debilitating depression and anxiety often require face-to-face intervention, sometimes including medication.

The effectiveness of cCBT is based, in large part, on its ability to replicate key elements of what occurs in face-to-face CBT, which relies heavily on active client involvement with the treatment process. Specifically, both these modalities incorporate these fundamental interventions:

Identifying your specific mental health challenge and how your thinking (or self-talk) perpetuates it.
Clarifying how your thoughts trigger your emotions and, subsequently, your behaviors.
Teaching you to think about your issue in a different, more helpful way.
Helping you challenge self-defeating thoughts while replacing them with more useful and positive ones.
Lowering your emotional reactivity to people and events in deference to more thoughtful and reasoned responses.
Increasing the variety and range of self-care behaviors that diminish the negative impacts of your mental distress.

Not a one-size-fits-all solution

Like other approaches to addressing mental health challenges, cCBT does not work for everyone or every issue. Persons with severe mental health challenges, like destructive addictions, suicidal impulses, intractable depression, debilitating anxiety, schizophrenia, bipolar disorder and the like, often require more traditional and intensive forms of care. All cCBT programs seek to rule out users who are not likely to benefit from this kind of treatment, instead offering them resources more appropriate for their concerns.

When indicated, cCBT, like its in-person counterpart, often results in lasting change. Why? In part because it helps the user clearly understand and positively influence the think-feel-act sequence underlying many mental challenges. When we know why we feel and act the way we do and learn how to take charge of our thoughts and the emotions and behaviors they create, our well-being increases.

Increasingly, traditional forms of talk therapy are migrating to digital platforms, including video chat, behavioral gaming and cCBT. These approaches show considerable promise in making effective mental health care more accessible, convenient and affordable. The bottom line? When used properly and according to researched clinical guidelines, cCBT can often make a positive difference in one's life, not just in the immediate future but over the long term, as well.

Philip Chard served as president and CEO for Empathia, Inc. for over 30 years and continues to serve client organizations as a consultant. Empathia has been helping organizations and individuals to be their best for over 35 years. The company began in 1982 as an internal employee assistance program (EAP) for a regional medical center and now provides highly customized and successful behavioral health and crisis management programs to companies across the globe.

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Cognitive behavioral therapy & the growing trend of online mental health programs

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