Breaking Down Barriers: How iCBT and its best practices can make psychotherapy accessible to all

by: Peter Farvolden


Cognitive behavioural therapy (CBT) has established itself as a form of structured psychotherapy with the evidence for effectively treating a wide range of disorders including depression, anxiety, Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), substance abuse, and insomnia among others. It is considered, amongst health professionals, as the gold standard psychotherapy for achieving results that are consistent with other first-line treatments, including pharmaceutical interventions.

For all its efficacy, the accessibility of CBT is highly constrained by barriers such as limited supply of qualified professionals – particularly in under-services areas, time, affordability, and social stigma. In Canada and abroad, there is an undeniable care gap in providing a proven mental health solution; in order to move beyond these barriers to care, innovation must play a crucial role.

One such example of an innovative approach is with internet-delivered Cognitive Behavioural Therapy, or iCBT, which is CBT delivered to a patient’s mobile device, tablet, or personal computer. This emerging form of therapy has gained much traction elsewhere – Australia’s widely-recognized MindSpot Clinic, as an example, has made iCBT a free service that treats 20,000 adult patients annually1.

The overall structure of iCBT remains as clinically robust and intact as its face-to-face counterpart; it is fundamentally about a skills-building approach, with best practices grounded in four core components.

    1. A Rigorous, Patient-Facing Assessment
    This is used by a therapist to create a customized care path based on the results. Since the therapist will never physically meet or speak with the patient, it is important that this assessment is thorough enough to provide the insight necessary to accomplish this.

    2. Adaptability
    When creating a patient’s care path, iCBT must be customizable to ensure that the program addresses all the individual’s mental health concerns holistically. In BEACON, for example, a therapist may be using therapy content from depression protocol, but they may also weave in additional components such as sleep hygiene.

    3. A Dedicated, Involved Therapist
    In order to ensure that a patient receives that support they need throughout a program, a therapist must be present and involved throughout. Therapists practicing iCBT need to be trained and regularly audited for the formation of alliance through digital interaction.

    4. Measurability
    This involves the tracking of symptom reduction, mental health improvement, and patient satisfaction among other factors. Without measuring results, it would be exceedingly difficult to know the overall impact of a full course of iCBT.

Making iCBT available can yield positive, ongoing results. Yet, of the 20 per cent of Canadians currently suffering from a mental illness, two-thirds are not seeking support2.

These statistics speak to a lack of accessibility to mental health resources – a care gap that leaves up to 7.5 million Canadians struggling.

Canadians are not finding the support they need for various reasons: in-person care is expensive, and not publicly funded for the broad population; many parts of the country suffer from a shortage or complete lack of qualified mental health professionals; elsewhere, Canadians are simply unable to travel the physical distances required to seek out support; time constraints and social stigma also create difficult barriers.

In Canada, we are lagging when it comes to accessible mental health support. We must collectively embrace innovative, new ways to provide mental healthcare solutions such as iCBT that adheres to rigorous best practices, is affordable, and is ultimately designed to improve the quality of life for Canadians.

Peter Farvolden, PhD, CPsych (drfarvolden@cbtassociates.net) is Clinical Director with the MindBeacon Group. He directs the development and delivery of the BEACON digital cognitive behavioural therapy (iCBT) platform, aiming to provide more Canadians with access to effective mental health care. Dr. Farvolden has held research, clinical and administrative positions at multiple settings, including the University Health Network (UHN) and The Centre for Addiction and Mental Health (CAMH). Dr. Farvolden is also the Clinical Director of the CBT Associates psychology clinic network.
References:

Annual Review of Clinical Psychology, Vol. 14:159-183. (2018) Realising the Mass Public Benefit of Evidence-Based Psychological Therapies: The IAPT.

1MindSpot

2 https://ccla.org/current-state-mental-health-canada/

National Health Service (NHS) (2019) Adult Improving Access to Psychological Therapies programme, NHS e-Newsletter.

Canadian Civil Liberties Association: The Current State of Mental Health in Canada