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Digital Cognitive Behavioral Therapy – Focus on Effectiveness

digital cognitive behavioral therapy

The Evidence Is Still Unclear on Digital Cognitive Behavioral Therapy

For many clients, barriers to accessing alcohol and other drug treatment stem from the availability or practical accessibility of services as well as considerations of anonymity and autonomy and stigma.  

Digital cognitive behavioral therapy treatments (also known as computer delivered interventions, and computer assisted interventions) offer a means for mitigating the impact of some or all of these barriers to care. Digital treatments offer several potential advantages over traditional delivery modalities, not least being their ability to help a greater number of people access treatment 

Several early reviews of computer-delivered interventions for a range of high-prevalence mental health disorders (e.g. depression and anxiety) were promising, suggesting that this modality offered similar efficacy to traditional face to face delivery.

However, this early enthusiasm has been tempered by methodological issues with much of the available literature, not least the large variation in how digital treatment interventions are operationalised, delivered and evaluated. 

The overwhelming majority of substance disorder focused digital treatments have been based on Cognitive Behaviour Therapy foundations, albeit with considerable variation in how Cognitive Behaviour Therapy has been implemented, and how faithfully the treatment has been represented. 

These include variations in frequency, intensity and involvement of the clinician. 

Programs can be provided as completely self-guided activities (similar to traditional self-help approaches) or as combined self-guided/clinician supported modalities. Clinician support is provided as structured or ad-hoc contact via face to face, telephone or video-based sessions, or text-based interactions. Digital treatment resources can also play a role as adjunctive elements supporting traditional face-to-face interventions (for example, assisting with treatment adherence and homework compliance). 

Effectiveness of digital cognitive behavioral therapy treatment

There have been a number of systematic reviews of the effectiveness of digital treatment approaches for alcohol and other drug use disorders, indicating broad preliminary support for these interventions as effective means for reducing rates of alcohol and other drug use compared to treatment as usual approaches (See Bickel et al., 2011; Moore et al., 2011; Marsch and Dallery, 2012). 

However, it is difficult to estimate the overall effectiveness of Cognitive Behaviour Therapy based online treatments for alcohol and other drug use disorders given the wide variety of digital intervention types, structures, populations and alcohol and other drug use types targeted. 

There may be differential effectiveness for these programs based on substance type. A 2017 meta-analysis of the effectiveness of digital treatments for illicit substances found that when viewed across all substance types internet-based interventions demonstrated small but significant effect sizes in terms of decreasing use compared to control conditions, and these effects appeared to be retained at follow-up, but there was too few high quality studies to be confident that their effectiveness was uniform across specific drug types.

Conclusion on digital cognitive behavioral therapy

The evidence base for digital interventions for alcohol and other drug use disorders exhibits some methodological weaknesses, including comparatively weak or inconsistent (wait list / information / treatment as usual) control conditions, and comparatively infrequent reporting of follow-up outcomes. 

Despite enthusiasm for the potential of digital modalities to reach larger numbers of individuals requiring treatment, and indications that these modalities are somewhat effective in modifying alcohol and other drug use behaviour, the current state of the evidence supports a prudent approach be taken to their widespread adoption as stand-alone methods of treatment. 

Click through if you are interested to learn more about Cognitive Behavioral Therapy.

Who are we?

360Edge is a leading Australian health consultancy, specialising in the alcohol and other drug, and allied, sectors. We provide a full suite of advisory services to help health service organisations accelerate change. We work with leading international organisations, governments and not for profit agencies across Australia and internationally.

Our vision is for a thriving service system that provides the best policy and practice responses right across the spectrum of alcohol and other drug use. We see a sector that has continuous improvement at its core and is resilient and adaptable to change. Our mission is to ensure governments and services have the tools they need to respond effectively and efficiently to people who use alcohol and other drugs to reduce harms.

We are driven to make a positive impact in the world and strongly believe in social justice and human rights, and it drives all of our work. We believe that everyone has the right to the opportunities and privileges that society has to offer. Our values of excellence, transparency and integrity are at the core of everything we do. We live these values within the team and with our customers and collaborators.

Our team of experienced ‘pracademics’ take a 360 approach to viewing situations from multiple perspectives. We collaboratively and holistically work with our clients at every stage, wherever they are in the cycle of change, to achieve their goals.