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Computerized CBT effective for substance use disorders

Computer-based cognitive behavioral therapy delivered in a clinical setting demonstrated safety, effectiveness and durability as a stand-alone treatment for patients with substance use disorders, compared with standard treatment approaches.

“We previously reported on the efficacy, durability and cost-effectiveness of computer-based training for cognitive behavioral therapy as an add-on to standard treatment for substance use in outpatient and methadone maintenance settings,” Brian D. Kiluk, PhD, assistant professor of psychiatry and director of technology-based interventions at Yale School of Medicine, and colleagues wrote. “However, these trials did not address the efficacy of [computer-based training for cognitive behavioral therapy] alone, an important step in establishing its efficacy and utility in the health care system.”

Researchers examined the efficacy and safety of computer-based training for cognitive behavioral therapy (CBT4CBT) as a stand-alone treatment and clinician-delivered CBT compared with treatment as usual in a heterogeneous sample of 137 adults with substance use disorders in a randomized clinical trial. Researchers evaluated whether substance use would decrease among patients who received clinician-delivered CBT or CBT4CBT compared with those who received standard treatment, and whether the effects of either form of CBT would endure through a 6-month follow-up period.

Kiluk and colleagues randomly allocated patients to receive treatment as usual, weekly individual CBT or CBT4CBT, which was delivered with minimal clinical monitoring weekly. The investigators assessed patients before treatment, weekly during treatment and at the 12-week treatment endpoint as well as at 1, 3 and 6 months post-endpoint.

Of 137 participants assigned to treatment, 123 completed at least one session and data were collected from 120 participants at 12-week assessment. Although the rates of assessment completion at treatment termination significantly differed by group, the participants with the best retention were in the CBT4CBT group and the worst were in the individual CBT group. Analysis showed greater reductions in frequency of any drug or alcohol use over time among participants who received clinician-delivered CBT (P < .01) and for CBT4CBT (P = .02), compared with treatment as usual.

Compared with treatment as usual, CBT4CBT plus clinical monitoring indicated sustained effects over treatment as usual. Results from the 6-month follow-up did not show benefit over treatment as usual for clinician-delivered CBT. According to the authors, participants who received CBT4CBT also showed the best learning of cognitive and behavioral concepts, and the highest satisfaction with treatment.

“This study provides strong support for CBT4CBT as an efficacious treatment for substance use, even when offered with limited clinical contact,” Kiluk and colleagues wrote in the American Journal of Psychiatry. “Web-based CBT4CBT not only may broaden access to an evidence-based treatment, but it also may be a more appealing option for many individuals.” – by Savannah Demko

Disclosures: Kiluk reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.