History and Current Status of ICBT

A new book – Guided Internet-Based Treatments in Psychiatry – has just been published by Springer. It is a 12 chapter stong book. Together with  Gerhard Andersson and Nils Lindefors I have cowritten the first chapter entitled History and Current Status of Internet-Based Cognitive Behavior Therapy.

We begin the chapter with a discussion of the history of Internet-based cognitive behaviour therapy (ICBT) and its roots in bibliotherapy and computerised CBT. We then provide a brief description of one way of administering guided ICBT, including the role of the therapist and data security issues. This description is followed by examples of conditions that are not covered later in the book, such as specifi c phobias and addictions. We end this chapter with a discussion of technical developments, cost-effectiveness and implementation.

This is the text from the first page:

In order to uncover the origin of Internet-based cognitive behaviour therapy (ICBT), it is important to acknowledge the different strands in the literature. One source of differentiation is choice of treatment format. There are two treatment formats of particular importance. The fi rst is cognitive behaviour therapy (CBT), which is the most well researched form of psychotherapy. CBT is also increasingly used in health care, particularly for the treatment of mild to moderate psychiatric conditions (Andersson et al. 2005). Arguably the most evidence-based psychological treatment, CBT is now disseminated on a wide scale in countries like the United Kingdom (Layard and Clark 2014). It is beyond the scope of this book to discuss CBT in detail, but we can outline a few of its key characteristics. The fi rst step in CBT is a case conceptualisation, which can be more or less behavioural in its orientation.

The next step is typically to present a treatment rationale to the patient. The subsequent treatment steps may vary depending on the agreed-upon treatment goals, but behaviour problems (too much or too little) and irrational beliefs are common targets, so specifi c treatment techniques have been developed to address them (Westbrook et al. 2011). These specifi c treatment techniques include behavioural activation in the treatment of depression and exposure when treating anxiety and avoidance. These techniques are framed using a rationale based on a cognitive and/or a behavioural conceptualisation. CBT is often focused on problems “here and now”, and recipients of CBT are instructed to practise techniques both during sessions and between sessions in the form of homework. The duration of the treatments may vary, but time constraints typically limit treatment to 10–20 weeks. However, there are examples of shorter treatments (like one-session treatments of specifi c phobia) and longer treatments (like dialectical behaviour therapy for borderline personality disorder, in which the first phase alone can last a year). Finally, relapse prevention and follow-up sessions may be included as well by the end of the treatment. While that concludes our overview of the execution of CBT, there are many more CBT techniques and procedures that we did not discuss, such as relaxation techniques, mindfulness, response prevention and specifi c cognitive techniques like Socratic questioning (this is sometimes, but not always regarded as a CBT technique).

The key to CBT’s success is likely the fact that treatments are adjusted according to the problem at hand (Barlow 2004). Thus, CBT for chronic pain will differ from CBT for something else, such as post-traumatic stress disorder (PTSD), even if there is some overlap. Another factor that uniquely characterises CBT is the way it is delivered. Whereas standard psychotherapy is typically done in the form of individual face-to-face treatment, CBT has been conducted in many different forms, such as group, family and couple therapy. CBT has even been done in a large lecture format. However, most noteworthy to us is the vast literature on CBT as self-help (Watkins 2008).

Andersson, G., Carlbring, P., & Lindefors, N. (2016). History and Current Status of ICBT. In N. Lindefors & G. Andersson (Eds.), Guided Internet-Based Treatments in Psychiatry (pp. 1-16): Springer International Publishing.