A digital cognitive behavioral therapy (CBT) program was more effective than clinician-delivered cognitive behavioral therapy in increasing alcohol abstinence in patients over an 8-month study period, according to a new Yale study.
The study, published in JAMA Network Open, found that clinical trial participants assigned to the web-based therapy program, known as CBT4CBT, increased their percentage of days abstinent from alcohol by more than 50 percent, a significantly greater rate of improvement than standard outpatient care or clinician-delivered CBT.
CBT is an evidence-based treatment for alcohol use, consisting of practical exercises to help patients cope with stress and other triggers of alcohol use. The digital CBT4CBT program features videos with actors using cognitive behavioral skills as well as interactive exercises, quizzes, and practice exercises.
Study results revealed the digital program plus brief monitoring outperformed clinician-delivered CBT in terms of increasing alcohol abstinence, as well as the frequency of cognitive and behavioral coping strategies.
Researchers say the results provide support for the efficacy of CBT4CBT at reducing alcohol use and increasing abstinence when provided alongside minimal clinical support.
“The number of web or mobile applications that target mental health conditions has grown exponentially over the past decade, but the quality of the content is quite mixed and very few have empirical support demonstrating they are effective. CBT4CBT is one of the exceptions,” said Brian D. Kiluk, PhD, associate professor of psychiatry and lead author of the study.
“CBT4CBT is grounded in evidenced-based cognitive and behavioral strategies for reducing alcohol use and teaches the strategies through an entertaining format that provides a fun way to learn,” he said. “Importantly, this study provides further evidence that CBT4CBT is effective when offered with minimal clinical support to help people reduce their alcohol use.”
Kiluk, director of the Yale Psychotherapy Development Center, said the digital program is not intended to replace therapists or providers. “Rather (it) gives (providers) a way to offer their patients easier access to effective cognitive and behavioral tools to address substance use,” he said.
CBT4CBT, was developed by the late Kathleen M. Carroll, PhD, Albert E. Kent Professor of Psychiatry, and other members of the Yale Psychotherapy Development Center in 2008. The intent was to provide consistent and high-quality delivery of cognitive behavioral therapy skills training to avoid substance use.
In this study, the clinical trial involved 99 participants, with some assigned to the digital program and some assigned to either standard care or CBT provided by a therapist. The study period was for eight months.
Other contributors to the study from Yale include Bryan Benitez, PhD, associate research scientist; Elise DeVito, PhD, associate research scientist; Tami Frankforter, systems programmer/data manager; Donna LaPaglia, PsyD, associate professor of psychiatry; Stephanie O'Malley, PhD, Elizabeth Mears and House Jameson Professor of Psychiatry; and Charla Nich, data analyst/manager.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.
Kiluk is a consultant for CBT4CBT LLC, which makes versions of CBT4CBT available to qualified clinical providers and organizations on a commercial basis. This conflict is managed by Yale University.