Computer-assisted cognitive behavioral therapy (CCBT) and mobile mental health applications warrant continued development and ongoing efforts to increase acceptance among patients and clinicians, according to a study published in the Journal of Psychiatric Practice^®which is part of the Lippincott portfolio of Wolters Kluwer.

Based on a comprehensive search of the medical literature, Matthew Mishkind, PhD, of the Department of Psychiatry, University of Colorado at Aurora, Jesse Wright, MD, PhD, of the Department of Psychiatry and Behavioral Sciences, School of Medicine from the University of Louisville, and colleagues say that “the evidence for the effectiveness and efficiency of CCBT is sufficient to warrant wider dissemination in clinical practice.” Additionally, some mental health apps are effective in reducing symptoms of anxiety and/or depression, at least during short-term use.

Distinguish the two types of technology

The reviewers define CCBT as “a digital tool with a series of user interactions intended to provide a program of core CBT methods for a psychiatric disorder.” They explain that most CCBT programs are designed by clinicians with expertise in CBT, are intended to be guided or supported by clinicians, and place a high priority on patient confidentiality and safety.

The primary benefits of CCBT are its documented ability to significantly reduce the time and effort required on the part of clinicians while making treatment less expensive and more convenient for users. The dropout rate, however, may be higher than in conventional practice, and few U.S. insurers offer reimbursement. Understanding patient populations and their expectations is important for managing dropout rates.

Multiple systematic reviews and meta-analyses have reported medium to large effect sizes for clinician-supported CCBT, the group found, while effect sizes for unguided CCBT are less robust. The article includes a list of programs that have been shown to be effective in at least two randomized, controlled trials for the treatment of depression and/or anxiety.

Unlike CBT, mobile mental health apps typically offer one or more of the CBT activities, but not a comprehensive treatment program for a psychiatric disorder. Evaluators say well-developed apps can complement in-person treatments by providing real-time status updates to providers, engaging patients between sessions, and alleviating barriers to access. They can also help patients practice new strategies and behavioral skills outside of regular therapy sessions.

However, despite the proliferation of mobile mental health apps, few are backed by scientific evidence for behavior change. Unfortunately, some serve inaccurate content and sharing sensitive user data is common. While most apps can be downloaded for free, more than half require in-app purchases to unlock full features.

Clinicians should guide patients in using CCBT or mobile apps

Dr. Mishkind, Dr. Wright and their colleagues make recommendations for how clinicians can implement CCBT and mobile apps in their practices:

• Determine the clinical case; Define the problem to be solved and decide which tool is most appropriate

• Use the program or app yourself to learn its features before suggesting it to patients.

• Teach patients the program or application; Explain how to access it; describe the main functionalities; suggest a good pace of use; and describe your role in facilitating learning

• Provide ongoing support; Use the tool as part of a comprehensive, multifaceted treatment plan and continually discuss progress with the patient.

“CCBT and/or mobile apps are currently an integral part of some comprehensive treatment plans and practices; however, it is likely that most clinicians have not yet fully explored these options or integrated them into their daily work,” the authors observe. “We believe that the evidence for the effectiveness and efficiency of CCBT is sufficient to warrant wider dissemination in clinical practice.”