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Digitizing Mental Health Support Through Internet-Delivered Cognitive Behavioral Health (iCBT) Technology
Session 207, Thursday, February 14, 2019l
Joe Blomeley, Senior Vice President, Public Sector and Ontario Region Morneau Shepell
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Joe Blomeley, Morneau Shepell
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Current mental health challenges
• What is iCBT? Digital behavioral health
• What the research says
• Opportunities for organizations
Agenda
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• Identify how iCBT technology can provide a better user experience
and increase the likelihood of users successfully completing their
therapy plan
• Define the development of effective, clinically sound, and
accessible iCBT programs for mental health support
• Recognize how behavioural health solutions that are delivered
digitally have broad appeal for those eager to access non-
traditional forms of treatment for mental health issues
Learning Objectives
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Physical
Symptoms
Thoughts Emotions
Behaviors
Mental health issues continue to rise - Not sustaining the increase
Public and private health care systems cannot meet the demands – economically or operationally
Rapid technological growth CBT
Emerging as an in-demand, respected, measurable, effective, and validated behavioural health approach
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Psychological benefitsemployee selects who they want
to see (lots of variation in practice)
Disabilityis the same issue as
psychological benefits no over
site or standard of practice
Health Caregaps, wait lists, not enough
expertise in all locations
Fragmented
on public and private health =
disorganization of health care and
we are not doing as well as we
could be
Pockets of excellence hard to ensure a standard of
practice in all location and with all
diversity issues
Mental Health Challenges in Both Public and Private
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Multiple Factors are Driving the Need for iCBT
What
EVERYONE
wants:
• Clinically-
proven
solution
• Cost effective
• Easy to
access and
use
• User friendly
• Support mild-
moderate
Increasing demand from consumers
for easily accessible, digitally-driven
MH products
Consumers
Public Healthcare
Public systems are over-burdened,
fragmented and under-equipped
Insurers
Need to better support MH related
disability cases. Need to modernize
paramedical benefits
Employers
Dealing with spiraling MH disability,
productivity and drug costs
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CBT
skill based approach therapy
focuses on changing negative thought patterns, emotional responses and behaviors.
iCBT
provides the effectiveness of CBT with the convenience of an online program using online education, videos and assignments guided by a therapist
iCBT
iCBT program combines
a therapist with a state of
the art program to create
an effective platform to
improve on traditional
therapy
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Three Pathways to Access iCBT
Self DirectedClients learn about iCBT through their workplace
promotions or self-initiated search for help.
EAP ReferralClients are triaged to iCBT via the EAP (if
appropriate) and employers have iCBT as
part of service contract.
Case Manager ReferralClients are referred to iCBT by a case
manager as part of a disability management
case.
The iCBT
journey
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Emerging Health Trend
Vertical Integration
• will transform the healthcare landscape
• move from point solutions to platform solutions for
healthcare
Platform Solution
• engagement
Patient & Consumer
• interactive voice, blockchain
AI & New Technology
Technology
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• Accelerated assessment and treatment
• A whole-person approach to client/patient care in one setting
• Behavioural health is no longer one-size-fits-all
• Extending and changing mental health issues
• Compelling Clinical value of reaching people who would not use traditional supports
Digital behavioral health opportunity
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iCBT – A blended, client-centered approach
Clinically
validated
assessment tool
Personalized
action plan
is created for
each case
Digital modules
for each
program with
educational
content,
clinically
validated
exercises
The therapist
uses report
from the
module to
guide the
treatment plan
User
receives a
final report
of progress-
they can
choose to
redo
modules
An ecosystem that responds 24/7/365 to client needs
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• “Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders.” 3
• “CBT was somewhat superior to antidepressants in the treatment of adult depression” 3
• (In review of) 106 meta-analyses examining CBT showed strong support for effectiveness and support for greater effectiveness than other therapy methods. 2
• “Cognitive Behavioural Therapy (CBT), has been shown to be effective in activation of cognitive control regions in the brain was in both Major Depressive Disorder and PTSD.” 1
Multiple studies support the effectiveness of CBT
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Experts agree: iCBT as effective as face-to-face CBT
“Across all 3
reviews, there is
support for iCBT as
appearing to result
in outcomes that
may be equivalent
to face-to-face
care.”4
“The answer to the
question ‘How
effective is guided
iCBT?’ is: ‘Just
about as effective
as face-to-face.” 5
“Results of iCBT and
face-to-face are not
significantly
different. Supervised
iCBT seems
preferred to assure
adherence and
promote exposure.” 6
Janine V. Olthuis, PhD,
Assistant Professor
University of New
Brunswick
The Internet and CBT, A clinical
guide. Page 60. Gerhard
Andersson PhD, professor,
Linköping University,
Linköping, Sweden
Miel Vugts, University of
Tilburg, The Netherlands -
personal communication
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The opportunities for organizations have significant value
A reduction in the duration and cost of absences
Cost effective method of supporting employees
with proven results
Offering employees alternative therapy options
Helping employees return to productive health
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1. Yang Z, Oathes DJ, Linn KA, Bruce SE, Satterthwaite TD, Cook PA5 Satchell EK, Shou H, Sheline YI. Cognitive Behavioral Therapy Is Associated With Enhanced Cognitive Control Network Activity in Major Depression and Posttraumatic Stress Disorder.Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Apr;3(4):311-319
2. Hofmann SG1, Asnaani A, Vonk IJ, Sawyer AT, Fang A.(2012) The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses Cognit Ther Res. 2012 Oct 1; 36(5): 427–440.
3. Butler AC1, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses, Clin Psychol Rev. 2006 Jan;26(1):17-31
4. Olthuis, Janine V., PhD, Assistant Professor University of New Brunswick
5. Andersson, Gerhard, PhD, professor, Linköping University, Linköping, Sweden. The Internet and CBT, A clinical guide. Page 60.
6. Vugts, Miel, University of Tilburg, The Netherlands - personal communication
References
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Barb Veder
Joe Blomeley
Please remember to complete online session
evaluation – you have just participated in
session 207.
Questions
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Multiple Choice Question #1
In high-income countries, what percentage of
people with mental disorders do not receive
support for mental health concerns?
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Multiple Choice Question #2
The measures of iCBT success should include:
A. Symptom reduction
B. Reduction of wait times for issue assessment and program support start
C. Improvement in overall function level
D. None of the above
E. All of the above
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True/False Question
iCBT can be as effective as in-person treatment
modalities
