Like many consumer-driven onlineservices, cCBT uses artificial intelligence or AI, and interactivealgorithms to approximate some of the same back-and-forth exchangesone might expect in face-to-face counseling.

As the demand for mental health services increases (1 in 5Americans need help at some point), providers are seeking new waysto assist the greatest number of people in the most efficientmanner. More often, they're turning to online andtelehealth therapy options.

Cognitive Behavioral Therapy (CBT) is among the most researchedand effective approaches used in counseling and psychotherapy. Thismethod focuses on examining and modifying one's inner self-talk,which, when it proves negative, catalyzes emotional states andbehaviors that undermine well-being. Often used to treatdepression, anxiety, stress, eating disorders, post-traumaticstress disorder (PTSD) and related mental challenges, CBT activelyengages patients in addressing these issues by learning new ways ofthinking, feeling and behaving that promote improved self-care andmental wellness. What's more, CBT has been used to assistindividuals with the psychological impacts of chronic medical conditions such as diabetes,pain, heart disease and other health challenges.

Related: Building a better behavioral health benefit withtelepsychiatry

Until the advent of the internet and mobile devices, CBT wasprovided almost entirely through face-to-face sessions. However,increasingly, mental health organizations are offering an onlineversion of this approach called "computerized CBT," or cCBT forshort. Like many consumer-driven online services, cCBT usesartificial intelligence or AI, and interactive algorithms toapproximate some of the same back-and-forth exchanges one mightexpect in face-to-face counseling. In this sense, AI assumes therole of "therapist." Most cCBT programs involve a series of onlinesessions and interactive experiences conducted over a period ofweeks. Frequently, the client is assigned specific "homework" tocomplete in between sessions. Some cCBT formats are entirelyAI-driven, while others offer the user the option to interact witha live counselor when additional guidance is needed.

Why the need?

The impetus for this new platform stems from a varying array ofneeds.

1. The challenges facing those in rural communities in accessingcounseling resources.
2. The increased preference among consumers of mental healthservices for immediate, 24/7 accessibly that provided maximumconvenience and privacy.
3. Nearly 3 out of 4 in need of mental health therapy will notseek in-person therapy due to social stigmas or accessibilitylimitations.
4. The increased confidence, through studies and research, thatcCBT is just as effective as in-office therapy.

Does it work?

Research into the effectiveness of cCBT is ongoing and far fromcomplete. However, initial studies show considerable promise, andsome demonstrate that its efficacy is similar or equal to thatfound with traditional CBT. A variety of delivery platforms areavailable and it will take time to clarify which yields thegreatest benefits. What's more, research of this kind requireslong-term studies that follow clients over many years to fullyconfirm longitudinal results.

However, while few studies have examined the impact of cCBT onmeasures of employee performance and well-being (e.g., absenteeism,productivity, mental health insurance claims, etc.), manyresearchers assert that improvements were seen in clients treatedwith this modality in clinical settings likely translate into theworkplace. The expectation, then, is that improvements indepression, anxiety and stress-related disorders seen among cCBTusers, in general, should show positive impacts on employeeperformance and well-being in specific.

What we do know is that cCBT, like its face-to-face version, ismost effective in addressing the following types of unhealthymental tendencies:

• Negative Cognitive Bias: The subconscioushabit of seeing only the negatives in one's life and few, if any,of the positives.
• Overgeneralization: Assuming all happeningsand people are the same, based entirely on one or a very fewnegative experiences.
• Catastrophizing: Certainty that the worst-casescenario one is worrying about, will come to pass.
• Fallacy of fairness: Believing the worldshould be fair and just, and that one can make it so by doing allthe right things.
• Blaming: Assigning responsibility for one'sdistress or unhappiness entirely to one's self, others orfate.
• Shouldism: Applying a rigid set of beliefs andjudgments to one's self, while also expecting others to conform towhat one believes they should or should not do.
• Perfectionism: Expecting one's self (orothers) to never make mistakes and meet unrealistically highstandards of behavior and performance.
• Emotional certainty: Maintaining the beliefthat, "If I feel it, then it must be true."

In terms of specific challenges, cCBT has been studied most inrelation to anxiety and depression, the two most common mentaldisturbances. Here, it has shown considerable promise in treatingthese conditions, at least among those with mild to moderate cases.Severe and debilitating depression and anxiety often requireface-to-face intervention, sometimes including medication.

The effectiveness of cCBT is based, in large part, on itsability to replicate key elements of what occurs in face-to-faceCBT, which relies heavily on active client involvement with thetreatment process. Specifically, both these modalities incorporatethese fundamental interventions:

• Identifying your specific mental health challenge and how yourthinking (or self-talk) perpetuates it.
• Clarifying how your thoughts trigger your emotions and,subsequently, your behaviors.
• Teaching you to think about your issue in a different, morehelpful way.
• Helping you challenge self-defeating thoughts while replacingthem with more useful and positive ones.
• Lowering your emotional reactivity to people and events indeference to more thoughtful and reasoned responses.
• Increasing the variety and range of self-care behaviors thatdiminish the negative impacts of your mental distress.

Not a one-size-fits-all solution

Like other approaches to addressing mental health challenges,cCBT does not work for everyone or every issue. Persons with severemental health challenges, like destructive addictions, suicidalimpulses, intractable depression, debilitating anxiety,schizophrenia, bipolar disorder and the like, often require moretraditional and intensive forms of care. All cCBT programs seek torule out users who are not likely to benefit from this kind oftreatment, instead offering them resources more appropriate fortheir concerns.

When indicated, cCBT, like its in-person counterpart, oftenresults in lasting change. Why? In part because it helps the userclearly understand and positively influence the think-feel-actsequence underlying many mental challenges. When we know why wefeel and act the way we do and learn how to take charge of ourthoughts and the emotions and behaviors they create, our well-beingincreases.

Increasingly, traditional forms of talk therapy are migrating todigital platforms, including video chat, behavioral gaming andcCBT. These approaches show considerable promise in makingeffective mental health care more accessible, convenient andaffordable. The bottom line? When used properly and according toresearched clinical guidelines, cCBT can often make a positivedifference in one's life, not just in the immediate future but overthe long term, as well.

Philip Chard served as president and CEOfor Empathia,Inc. for over 30 years and continues to serve clientorganizations as a consultant. Empathia has been helpingorganizations and individuals to be their best for over 35 years.The company began in 1982 as an internal employee assistanceprogram (EAP) for a regional medical center and now provides highlycustomized and successful behavioral health and crisis managementprograms to companies across the globe. 

Read more: 

• Expanding the footprint of care with telebehavioralcounseling
• Employer-sponsored benefits and the fight toimprove mental health
• Recognizing employee barriers to mental healthservices