New research suggests the efficacy of online cognitive behavioral therapy can be determined within a few weeks of the intervention. Early assessment of therapy outcomes allow practitioners to provide additional support and adjust care plans as needed.
Scientists in Sweden developed the technique to identify patients who face a major risk of treatment failure. Their results also suggest that such patients may nevertheless benefit if their treatment is adjusted to accommodate their specific needs and challenges.
The study findings appear in the American Journal of Psychiatry.
Internet-delivered CBT effectively addresses depression, panic and sleep disorders, and several other psychological issues. Many studies over the past 20 years have demonstrated benefits that are comparable with traditional face-to-face treatment. As a result many clinical practice have adopted the approach.
However, as is the case with any method, not everyone benefits the same. Moreover, researchers have not found a way to prospectively separate those who are likely to benefit from online CBT from those who do not.
The adaptive treatment strategy evaluated by investigators at Karolinska Institutet permits such a classification within a few weeks into therapy. The results come from a study that included 251 patients who were receiving Internet-delivered CBT for insomnia.
“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,” says Erik Forsell, a psychologist and PhD student.
After four weeks of Internet-delivered CBT, the clinicians 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 additional support and an adjusted treatment.
High risk patients who continued with the standard treatment obtained less reduction in sleep problems, whereas those who received additional support and the adjusted treatment obtained similar benefits as those in the low-risk group.
Researchers believe the study is a first step in customizing 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 strategy will help a greater number of patients and minimize the risk of extended therapies without desired benefits. The long-run consequences may be fewer failures and less time between diagnosis and effective treatment.
The healthcare system would be less burdened and individual patients would suffer less,” says Viktor Kaldo, psychologist and associate professor at the Department of Clinical Neuroscience, Karolinska Institutet, and the principal researcher.
Source: Karolinska Institutet