ICBT: expanding the advantages of Internet-delivered CBT

ICBT: expanding the advantages of Internet-delivered CBT
© iStock/KatarzynaBialasiewicz

According to Karolinska Institutet, Sweden, Internet-delivered CBT (cognitive behavioural therapy), or ICBT, may have a new adaptive treatment strategy on the horizon.

Scientists have experimented with a new adaptive treatment for Internet-delivered cognitive behavioural therapy (ICBT) that identifies patients within the first month who face a major risk of treatment failure. Could this new strategy expand the benefits of Internet-delivered CBT?

What do you know about Internet-delivered CBT?

ICBT effectively addresses depression, panic and sleep disorders, and multiple other psychological issues. Numerous studies over the past 20 years have established benefits that are comparable with traditional face-to-face treatment, and clinical practice has adopted the approach throughout much of Sweden.

However, not everyone benefits enough. Researchers are yet to find a way, prior to treatment, to separate those who are likely to benefit from those who are not.

Published in the American Journal of Psychiatry, the adaptive treatment strategy that was evaluated allows such a classification within a few weeks into therapy.

This particular study included 251 patients who were receiving Internet-delivered CBT for insomnia.

Accurately assessing patients

After four weeks of Internet-delivered CBT, the scientists performed a structured assessment of the individual risk of failure with a questionnaire and algorithm-based tool.

Patients were then classified as either facing a low risk or high risk of failure, i.e., obtaining insufficient benefits. Those at high risk were randomly assigned to either continuing the treatment or receiving added support and an adjusted treatment.

High risk patients who continued with the standard treatment obtained less reduction in sleep issues, whereas those who received additional support and the adjusted treatment obtained similar benefits as those in the low-risk group.

Erik Forsell, psychologist and PhD student at the Department of Clinical Neuroscience, Karolinska Institutet, says: “The findings indicate that an accurate assessment of patients who are likely and unlikely to benefit is possible by the fourth week of treatment.

“The strategy also reduces the risk of insufficient outcome since it enables additional support and adaptation for those who need it.”

Customising ICBT

“The strategy will help a greater number of patients and minimise the risk of extended therapies without desired benefits.” Adds Viktor Kaldo, psychologist, associate professor at the Department of Clinical Neuroscience and the principal researcher.

The researchers believe that this study is the first step in customising Internet-delivered CBT, and ultimately traditional therapy as well, by constructing structured systems that identify and assist those who do not appear likely to benefit.

“The healthcare system would be less burdened and individual patients would suffer less.” Concludes Kaldo.


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