April 1st, 2014

Study: Online tool effective

Researchers at Yale University have developed a program to teach coping skills to alcohol and substance abuse patients. Lead author Kathleen Carroll, Ph.D., professor of psychiatry, hopes that eventually the computer-based cognitive behavioral therapy tool can be made available to practitioners throughout the northeast.

“It was a creative endeavor,” she says of CBT4CBT (Computer Based Training in Cognitive Behavioral Therapy), an interactive online program that is driven by video and audio and provides skills training in an entertaining way.

A study in 2014 replicated results from a 2000-2002 pilot project with its findings published in the American Journal of Psychiatry.

The researchers divided 101 cocaine dependent patients being treated with methadone into two groups: one receiving standard care and the other also getting CBT4CBT over an eight week trial. Patients receiving the latter treatment were significantly more likely to attain abstinence for three or more weeks (36 percent compared to 17 percent). They were also more likely to demonstrate continued improvement six months later.

Carroll says that one takeaway from the research is that it is relatively simple to add a slightly different twist to successfully teach patients a skill. “It’s cool,” she says, adding that the reliance on visuals is helpful for patients’ with memory problems and an effective means for them to grasp concepts.

The alcohol version of the program is a takeoff on the TV show, “The Office,” while a Spanish version is presented like a telenovela. A character in the movie walks the patient through assignments. Featured are quizzes, graphs and other interactive components that get patients to imagine themselves in different situations. For example, a Latino actress playing a grandmother checks in with the patient to see if he or she has done a homework assignment. If he has, she tells him, “you are great.” A patient who has not is nudged along with the character telling him, “Why don’t we do it now then?”

Carroll thinks the Spanish version in particular has tremendous potential. “I’d like to see it brought to the Latino substance abuse community, where there are disparities in access (to treatment).” She notes that finding a way to expand the program to reach people in rural areas or individuals reluctant to seek treatment in traditional ways is a goal. “I can see it being used at bedsides.”

Although the program is already being used within a few clinics, she acknowledges that expansion is a long way off and likely to meet with roadblocks such as a lack of insurance reimbursement codes. Nonetheless, Carroll would like to see cognitive behavioral therapy brought to community-based substance abuse centers where it is rarely used. “Clinical psychologists do fine with it in their private programs. They have more time to use it versus a place where there is a group session once per week. Any use of this (CBT4CBT) would have to be within a clinician atmosphere as an add on initially.”

The online program was met with some skepticism that it would replace therapists but Carroll emphasizes that’s not the intention. “It’s a clinician extender that meets patients where they are at and takes care of problems. It helps both the clinician and patient learner.”

Future research will focus on comparing the computer version therapy with minimal clinician involvement versus use with a closely supervised clinician. “There are a lot of questions,” Carroll says. “Does it act like clinically supervised CBT? For whom is it most effective?”

By Susan Gonsalves

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