Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
therapist (Wright & Caudill, 2020). Alavi et al. (2020) estimate that virtual CBT delivery methods could increase capacity for quality care by four. Research supported the use of computer-assisted cognitive behavior therapy (CCBT), with not only evidence for efficacy supported by randomized, controlled trials but also sufficient quality and security to be clinically useful (Wright et al., 2019). Internet cognitive-behavioral therapy (i-CBT), an early techno- logical offering, targeted psychotherapy barriers and accessibil- ity in an effort to decrease the treatment gap for people with no access to adequate care. I-CBT availed people of web-based self-help materials, including psychoeducational materials and CBT exercises (Wilhelm et al., 2020). Meta-analyses of I-CBT demonstrated superiority to wait-list control groups (Andrews et al., 2018), with approximately equivalent efficacy to face-to-face CBT treatment in randomized controlled trials (Carlbring et al., 2018). Research on computer-assisted cognitive-behavior therapy (CCBT) and mobile apps supported CCBT when used as part of a psychotherapeutic relationship, with little to no effective- ness noted for stand-alone CCBT treatments (Wright et al., 2019). Although increasing research was supporting virtual and web-based psychotherapeutic technologies, COVID CDC guidelines and government policies—quarantine and social distancing—challenged face-to-face therapy and gave researchers and clinicians a tremendous “real-life” opportunity to expand models of psychotherapy provision. Innovation of internet-based CBT (Komariah et al., 2022). Telehealth is not new, but it has now entered the clinical mainstream (Comer, 2021). The pandemic required “agility and innovation in practice” (Comer, 2021). Virtual and digital delivery of psycho- therapy has been shown to be efficient and clinically effective (Alavi et al., 2020) whether online, digital asynchronous, or synchronous. Although large survey studies find low acceptability for virtual mental health interventions, research indicated that explana- tion of treatment rationale was key. Recipients who received treatment rationale, including how a treatment works and effectiveness, were more likely to be “persuaded” to engage in virtual mental health services (Molloy et al., 2021) and specifi- cally iCBT (Molloy & Anderson, 2022). Citing the need to provide mental health services when trained clinicians are not sufficiently available (e.g., during the COVID-19 pandemic), German researchers examined unguided internet-based interventions for the treatment of depression, using the iFightDepression tool. Results indicated that not only are people more adherent to treatment when guided by a clinician, but they also benefit with symptom reduction (Oehler et al., 2021). Concerns regarding low levels of engagement and retention in digital interventions suggested the need for additional supports, from adjunctive coaches or therapists to provide additional support systems and to integrate accountability and the benefits of relationships/com- munity. Additionally, additional support and engagement may
• “We’re going crazy in the house. My husband is stricter than the CDC.” • “We’re struggling financially. If this continues, I don’t know what we’re going to do.” • “My kids can’t learn this way.” • “My parents are elderly and vulnerable. I’m scared for their health.” • “My husband’s mother lives in a nursing home, and no one can visit. She’s all alone.” • “Why don’t people just mask up and shut up?!” • “I get very anxious and just want to flee. But, we’re all locked down.” • “I don’t know what to trust.” • “We’re running out of hand sanitizer.” • “We have cases of toilet paper.” (Buying toilet paper was relatively inexpensive and allowed people to believe they were doing something important and productive; Zagorsky, 2020) • Cyberchondria. (Excessive time spent online resulting in information overload and increased health anxiety, worsening self-isolation and likelihood of unusual online purchasing behaviors (Laato et al., 2020). [See Table 2) TELE-MENTAL HEALTH AND VIRTUAL CBT: RESEARCH AND DELIVERY Prior to COVID, research on the effectiveness of technology- based or technology-supported CBT had a solid basis but was in early stages of development. Many researchers and clinicians expressed concern regarding utilization of web-based applica- tions (“apps”) as inferior to face-to-face psychotherapy sessions. In an effort to provide socially distanced mental health services that allowed for necessary quarantining and isolation of both patient and provider, mental health providers acted quickly to grow modernized approaches and develop “telecompetence” (Perle et al., 2022). CBT services provided virtually and digitally grew as an efficient and clinically effective method for meeting demand (Alavi et al., 2020). Internet and mobile app-based mental health interventions have demonstrated success in symptom reduction for widespread mental health issues, including depression, anxiety, stress, and substance abuse (Bennett et al., 2020) and offered the foundation for innovative approaches such as virtual reality for the treatment of anxiety (Shafran et al., 2021) and utilization of techno- logically provided exposure therapy to treat “technophobia” (Sherrill et al., 2022). Telehealth services were found to be effective and cost-effective when provided on commercially available encrypted video platforms while providing access to distanced care independently or self-guided, guided with the use of a peer or paraprofessional, or with support of the
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