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Computer-Based Training for Cognitive Behavioral Therapy – CBT4CBT

Novel computer program coaches people to avoid addiction relapse

Anna is under pressure. Her boyfriend Tony has drained her checking account to buy drugs, and now he wants Anna to get high so she can relax. “C’mon, let’s take a hit,” he tells her. The phone rings and it’s Anna’s friend — who presses her to join a birthday party at the bar.

What should Anna do? What would you do?

It’s a familiar scenario for many people in recovery: how to respond when confronted with drugs and alcohol.

Anna and Tony are professional actors in a novel, computer-based training program known as CBT4CBT (Computer-Based Training for Cognitive Behavioral Therapy). The program teaches people new skills to prevent addiction relapse — such as how to stand up for themselves and assertively refuse drugs and alcohol.

Like an engaging soap opera, the CBT4CBT vignettes feature contemporary story lines and plenty of melodrama. And the characters seem to resonate with their audience, according to several research studies sponsored by the National Institute on Drug Abuse (NIDA).

In one study, cocaine-addicted individuals who did CBT4CBT training for eight weeks were significantly more likely to stay abstinent than those on standard treatment alone (methadone maintenance). The study, published in April 2014 in the American Journal of Psychiatry, also showed that CBT4CBT participants reduced their use of other drugs and continued to improve at a six-month follow-up.

Q & A with the Creator of CBT4CBT:

Here’s a discussion with Dr. Kathleen Carroll, who developed the CBT4CBT program with her team at Yale University School of Medicine. Dr. Carroll, is the Albert E. Kent Professor of Psychiatry at Yale University School of Medicine and Principal Investigator of the Psychotherapy Development Center as well as Principal Investigator of the New England Node of the Clinical Trials Network, both funded by the National Institute on Drug Abuse (NIDA).

Why did you create a computer program for Cognitive Behavioral Therapy?

Dr. Carroll: I think it’s a wonderful way of helping more people get access to this evidence-based approach.  Its hard to find a good CBT therapist in a lot of settings, and it’s particularly hard in rural areas and for under-served populations.  It’s also much less expensive than a live therapist—all you need is Internet access, and the program is always there, 24/7.

We’ve worked hard to make the program relevant for all kinds of individuals who may be using any kind of drug or alcohol, and people can tailor it to their own needs. They can cover the material in any order they like, at any speed, and repeat material if they need a ‘booster’.

What does the research conclude about CBT4CBT?

Dr. Carroll: That our 7-session of CBT4CBT looks a lot like standard clinician-delivered CBT.  It increases abstinence within treatment, and the effects are durable even after people leave treatment.

The CBT4CBT episodes have the feel of a daytime soap opera. Was this intentional?

Dr. Carroll: We knew we had to teach skills, but wanted to do it in an entertaining and engaging way to keep the user’s attention.  Movies and stories featuring interesting people who are struggling with the same problems a lot of our patients struggle with, in real-life settings, and using everyday conversational dialogue seemed a great way to do this.  We’ve been doing psychotherapy research with addicted people for over 30 years at our clinics at Yale, and so had plenty of material to draw from.

We got lots of input and feedback from clinicians and patients as we built it, including the professional actors and directors we hired to do the movies—they got really into it and all of them said they learned a lot of CBT!

What are the drawbacks of using an e-learning platform to deliver therapy?

Dr. Carroll: The drawback is that the program can’t do much other than teach the skills and provide support for practicing skills outside of session.  Unlike a clinician, it can’t build a strong relationship or address other kinds of problems (emotional, medical, family), and it can’t intervene in a crisis, so that’s why we restrict its use to individuals enrolled in inpatient or outpatient treatment.

What’s the timeline for making CBT4CBT accessible to anyone in recovery?

Dr. Carroll: So far, we have only tested CBT4CBT as an add-on to standard care, that is, with a clinician seeing each individual regularly to evaluate substance use and other problems, address problems and crises that the computer isn’t designed to address, and so on.

We are currently conducting a study comparing CBT4CBT used alone (minimal clinician involvement) to standard care and CBT delivered by a clinician, and we’ll have those results in a year or two.  If CBT4CBT turns out to be safe and effective as a stand-alone, we would probably make it available directly to individuals.

We’ve only been making CBT4CBT available outside of clinical research studies for a few months, but four or five clinics have already picked it up.

How can someone in recovery find more information on CBT4CBT?

Dr. Carroll: A lot of information is available on our website, http://www.cbt4cbt.com/

The site includes a demonstration of the program and a lot of information about CBT and our work. CBT4CBT is a very new treatment, and it’s not yet reimbursed by insurance, so in order to move this to qualify for reimbursement, it’s important it gets out into clinical use.   If you look at the demo and think you’d like to try it, contact your clinician and see if they’d like to add CBT4CBT into their practice.

If you live in Connecticut or nearby, you might also be able to participate in one of our research trials—we’re currently testing CBT4CBT as treatment for both drug and alcohol use, and just started a study with a version for people who speak Spanish. You can find more information at http://www.pdc.yale.edu/index.aspx

Can you offer any advice to people seeking help for addiction?

Dr. Carroll: I think it’s important for people seeking help for drug or alcohol problems to become educated consumers. Some clinics still use practices that have not been shown to be very helpful or even harmful; it’s perfectly appropriate to ask the hard questions before enrolling or starting treatment: “What evidence-based approaches do you use here?”  “Which ones would you think would be most useful for me, and why?”  “What kind of outcomes can I expect from this clinic and how is it monitored?”

A recent book by Anne Fletcher, “Inside Rehab” has a lot of great tips and resources for finding treatments that work.

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