Less Intense Therapy Results in Increased Relapse
There is a great need psychological services that are brief, cost-efficient, and effective given the large number of individuals who experience mental health problems each year and the negative impact of these mental health problems on the individual and society at large.
As discussed in the British Psychology Society Research Digest, a new type of treatment called 'low-intensity' cognitive-behavioral therapy (CBT) has been tested in England. This low-intensity CBT is similar to full-intensity (i.e., regular) CBT in that it focuses on correcting cognitive distortions and teaching positive coping skills. However, low-intensity differs in that it minimizes face-to-face contact with a therapist and instead includes self-help books and exercises that are completed on the computer. Instead of a therapist, low-intensity CBT uses a coach with experience in administering this program, as opposed to a therapist with mental health and therapy training.
Sounds like a decent enough set up, especially for people who maybe do not have the resources to pay to see a therapist weekly or even biweekly, and while self-help books have typically not had the great outcomes that therapy has, they are typically better than nothing. That being said, low-intensity CBT only makes sense if it is producing positive outcomes.
And this is where low-intensity CBT falls a little short unfortunately. Over half of the participants relapsed in terms of anxiety and/or depression symptoms within a year, which can be compared to approximately 29 percent who relapse from full-intensity within a year. That being said, both are still better outcomes than the approximately 76 percent of individuals who experience a return of depression symptoms after stopping taking medications for depression (research shows time and time again that learning new skills and ways of thinking are critical to preventing depression).
Interestingly, participant depression symptoms, but not anxiety symptoms, at the end of low-intensity CBT predicted relapse. Therefore, additional attention appears to be needed for individuals still endorsing depression symptoms at the end of treatment, perhaps with additional booster sessions (sessions that occur after treatment has concluded) or maybe with longer treatment.
To be fair to low-intensity CBT, the participants met with their coach an average of 7 times, which is definitely below the standard for regular CBT where individuals meet with a therapist typically for 10 to 20 sessions (although this number can vary widely depending on the treatment and problem to be worked on).
Ultimately more research is needed to determine whether there are components of low-intensity CBT that work well and components that do not work well. In addition, it will be important to determine whether these low-intensity CBT coaches or practitioners can be as effective as therapists in helping reduce depression and anxiety symptoms.
That being said, low-intensity CBT appears to have merit if it increases access to psychological services and provides at least some benefit to others. If it provides some treatment to individuals that would not have accessed treatment otherwise, then it is doing some good.
A significant concern is that low-intensity CBT might dissuade individuals who need full-intensity CBT from accessing this more intensive treatment by providing the illusion that the less intensive treatment is just as effective. Hopefully low-intensity CBT includes mechanisms that refer individuals to more intensive treatment should their symptoms not remit.
In sum, low-intensity CBT could be beneficial for some individuals with low to moderate anxiety and maybe depression symptoms, and more research is needed to better understand the critical components of self-guided treatment.
Article link: https://digest.bps.org.uk/2017/06/13/false-economy-half-of-low-intensity-cbt-clients-relapse-within-12-months/