Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
be offered via chatbot apps (“fully automated conversational agents”), avatars, asynchronous learning (on-demand, sched- uled emails), and peer support platforms (typically anonymous) (Wilhelm et al., 2020). When looking to incorporate apps or digital offerings into treatment, Wilhelm et al. (2020) highlighted areas for exami- nation and scrutiny: • Evidence and empirical support are needed for technology-based treatments as many apps are not only ineffective but may include inaccurate information . • Security and data protection should include collection, transmission, and use of personal health information (Wilhelm et al., 2020) . • When used to support psychotherapeutic work, mobile apps provide on-demand, portable skills- based training, coping strategies, and tracking, with “adequate qualify, security, and efficacy to be used in clinical practice” (Wright et al., 2019). Selection of apps for clinical use should include review of app integrity and reliability of content (Wright et al., 2019). In an effort to evaluate privacy, credibility, and user experience, PsyberGuide, a nonprofit, has partnered with the Association for Behavioral and Cognitive Therapies (ABCT) and the Anxiety and Depression Association of American (ADAA) to develop a Mobile App Rating Scale (MARS). (Wilhelm et al., 2020). Additionally, the American Psychiatric Association (APA) has developed an adaptable eight-question screening tool to help clinicians use mental health apps with patients appropriately (Lagan et al., 2021). Regression analysis conducted on people who had engaged in digital CBT for insomnia (dCBT-I) prior to COVID suggested fewer COVID stress-related symptoms and more mental health resilience. In comparison to adults who received sleep educa- tion, those who received dCBT-I reported fewer symptoms of insomnia, general stress, depression, and COVID-related cog- nitive intrusions. For dCBT-I completers, resurgent insomnia and moderate to severe depression were 51% and 57% lower (Cheng et al., 2021), suggesting not only treatment success but treatment success duration. Meta-analysis of 6,778 patients with depression and 6,556 patients with anxiety who received iCBT during COVID-19 demonstrated significantly lower post-treatment scores in anxi- ety and depression. Although both guided and unguided iCBT resulted in lower scores of anxiety and depression, measure- ments of engagement and adherence suggested were a good pre- dictor of success. This suggests the benefits of clinician-guided rather than solely self-guided iCBT intervention (Komariah et al., 2022). Similarly, seven-week-long individually tailored iCBT (vs. control) utilized customized interventions based
on symptom profile and preferences. Results demonstrated moderate to large effects on post-treat depression and anxiety (Aminoff et al., 2021). A meta-analysis of the effect of CBT on anxiety and depression during COVID-19 demonstrated significantly lower scores of both depression and anxiety in groups receiving (vs. not receiving) CBT treatment, with results supported also in an internet-based CBT subgroup (Zamiri-Miandoab et al., 2022) CBT delivered remotely during COVID-19 was found to be effective for treating disturbed grief. Treatment included six steps delivered remotely: setting the scene, encouraging involve- ment of a support person, explanation of CBT interventions, exposure, cognitive restructuring, and graded activation. Additional learning was offered by recording of sessions for later review and reinforcement of learning and writing assign- ments (Boelen et al., 2021) Virtual and technologically supported third-wave interven- tions were also found to be successful for many populations, including CBT (O’Hayer, 2021), eye movement desensitization and reprocessing (EMDR; Perri et al., 2021), and mindfulness (Al Ozairi et al., 2023). Research supports both CBT and EMDR as evidence-based psychotherapies for the treatment of trauma. Virtual brief EMDR and CBT were utilized as an early intervention with healthcare professionals and others reporting COVID-related trauma symptoms, with individu- als receiving seven sessions of either CBT or EMDR. Results indicated that virtual EMDR and CBT were equally effective, with both treatments reducing anxiety by 30% and traumatic and depressive symptoms by 55%, with maintenance of effects at follow-up (Perri et al., 2021). In addition to individual CBT provided via internet and tele- health, group interventions were found to be helpful. Group CBT intervention for treatment of social anxiety disorder resulted in participants who were highly engaged, satisfied with treatment, and reporting decrease in symptoms related to social anxiety (Nauphal et al., 2021). A third-wave virtual group offering cognitive-behavioral and mindfulness skills for older adults showed reductions in depression for the intervention group (none in waitlist group) that were maintained at one- month follow-up. As we might expect, participants reported a lower level of loneliness at post-intervention that did not maintain at follow-up, suggesting that the virtual intervention was not only treating their depression but providing needed social interaction (Shapira et al., 2021). CBT AND APPLICATIONS (“APPS”) Though in its infancy, research supports the use of many CBT apps for a wide range of mental health concerns (Rathbone et al., 2017). Mobile apps offer clients easy access and immediate support with coping strategies that may function as treatment or augmentation for treatment (Wright et al., 2019). For individuals who suffer from mental health conditions in areas where care is unavailable or inadequate, CCBT offers solutions to lessen the treatment gap (Wilhelm et al., 2020).
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