June 3, 2019

A New Approach to Self-Help

cognitive behavioral therapy, internet based cognitive behavioral therapy, behavioral health conditions

We bank online, shop online, plan global travel online and keep in touch with our families and friends online. Advances in technology continue to simplify our lives and bring convenience into our homes; but can the internet be leveraged in the same way to meet a need as personal as therapy?

A new behavioral health program from Partners HealthCare aims to do just that.

Cognitive Behavioral Therapy, or “CBT,” is a short-term therapeutic treatment for a wide variety of behavioral health conditions including depression, anxiety, eating disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among others. This type of therapy focuses on changing thought patterns, which differs from traditional talk therapy that typically focuses on a patient’s specific life events, feelings, and personal behavioral patterns. For example, a person may be compelled to focus more on the negative aspects of life or a situation and not notice the positive aspects. This, in turn, can lead to feelings of increased sadness, emptiness, and anxiety, or behaviors like withdrawing from others. Cognitive Behavioral Therapy can help patients break these patterns and interrupt thoughts or behaviors that can trigger more intense symptoms before they start.

Retraining the Brain from the Comfort of Home

Internet-based CBT, or “iCBT,” teaches patients these skills from the comfort and privacy of their homes. Originally developed by the School of Psychiatry at Australia’s University of New South Wales and St. Vincent’s Hospital, the iCBT program has demonstrated effectiveness in decreasing symptoms of anxiety and depression. In 2015, Partners HealthCare adopted the model and started testing pilots with help from researchers at McLean Hospital and the Partners Population Health team. Soon after, McLean researchers published a randomized controlled study which showed that the program significantly reduced depression symptoms for patients here in the United States.

Rachael*, a patient at Charles River Medical Associates (a group of Partners HealthCare affiliated primary care practices), had tried in-person CBT to help address her anxiety and depression, with no success. But when Jenn Doyle, a Behavioral Health Support Specialist (BHSS) embedded in Rachael’s primary care practice, recommended she try the internet-based version of CBT, Rachael thought she’d give it a try.

“It’s definitely a good supplement for seeing a therapist [for talk therapy],” says Rachael. “It’s nice to have things reframed in a way that makes them bite-sized and more approachable.”

“I find it extremely helpful to many patients who are willing to put in the effort to do the work,” says Doyle. “People who complete the program have significantly lowered their anxiety and depression symptom scores.”

The online program is offered through primary care practices on Epic across the Partner’s network, and offers three modules: one to treat depression, one for Generalized Anxiety Disorder (GAD), and one for mixed anxiety and depression. The treatment is composed of six lessons, framed in a comics-like format using relatable character personas. Users log onto the system to view a lesson, complete homework, and report on their activities, thoughts, and symptoms. Exercises throughout the lessons teach users how to identify, challenge, and change negative or distorted thinking patterns and maladaptive behaviors. New lessons become available each week until the patient completes the module.

“This way, they can do it in their own house, whenever they want,” says Doyle. “They don’t have to show up during business hours to a therapist’s office.”

While the Australian research group has developed many iCBT modules, Partners began by testing the module on depression. Since adding the Generalized Anxiety Disorder (GAD) and mixed anxiety and depression modules in December 2018, average monthly enrollment rates have jumped from 47 to 93 new patients a month across the practices that offer the program. Looking ahead, Partners is investigating adding new modules that address other behavioral health concerns and offering the modules in Spanish. The team is also exploring the functionality of an iCBT mobile app so patients could access the program directly on their phones.

Rachael is glad that programs like iCBT and other mental health supports are offered through her primary care office. “It feels like much more holistic, general care than I had received previously,” she says. “I really think that the spotlight on mental and emotional health has been fantastic for me, and it’s got to be great for other patients.”


Up Next: Explore our infographic to learn more about iCBT.

*Last name has been removed to protect patient privacy.

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