Psychotherapy by Computer: Are We Ready for Change?

In a recent meta-analysis published in the Journal of Clinical Psychiatry, our research group reported on findings of 40 studies of computer-assisted cognitive-behavior therapy (CCBT) for depression. We found solid evidence for the effectiveness of CCBT when it is partnered with a modest amount of support from a helping professional. The typical amount of clinician time involved in delivery of CCBT ranges from 1–4 hours, thus paring the need for clinician involvement by 2/3 or more.

With reduced cost, improved efficiency of treatment, better convenience for patients, and effectiveness that matches standard cognitive-behavioral therapy, one might predict that CCBT would soon enter the mainstream of psychotherapeutic practice. But CCBT is a relatively new paradigm for therapy, and innovation often takes decades before achieving its potential. Another recent article has suggested ways to accelerate widespread dissemination of CCBT. Lipschitz and her associates described a “research-to-practice gap in digital psychiatry” and recommended that implementation science be harnessed to develop strategies to enhance uptake rates and integration into complex systems of care. Examples of challenges that implementation science could address are: 1) fitting CCBT into the workflow of a clinical practice; 2) developing effective methods of introducing CCBT to patients and clinicians; 3) integrating CCBT with other elements of treatment plans; and 4) addressing attitudinal biases against the use of technology in psychotherapy.

Because computer technology pervades so many areas of contemporary life, it is hard to imagine that psychotherapy will remain in the pre-digital age. Research is gaining strong momentum on CCBT and mobile apps for psychotherapy. Developers are creating very appealing interactive programs and mobile apps that patients can use at times that are convenient for them. Employers and insurers are looking for ways to improve the delivery of psychiatric treatment. Patients are using the Internet to search for answers to their medical problems. It is time for clinicians to learn about CCBT and mobile apps and begin to incorporate technology into the practice of psychotherapy.

Financial disclosure:Dr Wright is an author of the Good Days Ahead program and has an equity interest in Empower Interactive and Mindstreet, developers and distributors of Good Days Ahead. He receives no royalties or other payments from sales of this program. His conflict of interest is managed with an agreement with the University of Louisville. He receives book royalties from American Psychiatric Publishing, Inc., Guilford Press, and Simon & Schuster. Dr Wright receives grant support from the National Institutes of Health (Agency for Health Care Research and Quality) and the Oticon Foundation.​