Computer-assisted CBT and mental health apps effective in reducing anxiety, depression symptoms

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

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

Distinguishing between the two types of technology

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

The principal advantages of CCBT are its documented capacity to greatly reduce the amount of time and effort required from clinicians while making treatment less costly and more convenient for users. The drop-out rate can be higher than in conventional practice, though, and few U.S. insurers provide reimbursement. Understanding patient populations and expectations is important to manage drop-out rates.

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

In contrast to CCBT, mobile mental health apps usually provide one or some of the activities of CBT but not a full treatment program for a psychiatric disorder. The reviewers say well-developed apps can supplement in-person treatments by providing real-time status updates to providers, engaging patients between sessions, and alleviating barriers to access. They also can help patients practice new behavioral strategies and skills outside regular therapy sessions.

However, despite the proliferation of mobile mental health apps, few are based on scientific evidence about behavior change. Unfortunately, some offer inaccurate content, and sharing of sensitive user data is common. While most apps can be downloaded for no charge, more than half require in-app purchases to unlock the full functionality.

Clinicians should guide patients in using CCBT or mobile apps

Dr. Mishkind, Dr. Wright, and colleagues make recommendations about 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 about the program or app-;Explain how to access it; describe the core features; suggest a good pace of use; and describe your role in facilitating learning

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

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