Cognitive behavioral therapy (CBT), a form of psychosocial intervention in which negative thought patterns are challenged in hopes of altering unwanted behavior patterns, is increasingly being offered online. The online format offers the potential to increase member accessibility, reduce plan costs through scale, and provide efficacy metrics for employers and individuals, among other features.
Online CBT is based on education and training to help people develop the skills to manage their own mental health, said Andrew Miki, Ph.D., chief executive officer of Starling Minds in Vancouver, British Columbia. Miki, who presented the International Foundation webcast “The Impact of Online CBT: A New Way to Support Mental Health and Decrease Costs,” has collaborated with the British Columbia Teachers’ Federation (BCTF) to implement an online CBT program for teachers. “CBT helps people to recognize, reduce and resolve problematic patterns to become more resilient to stress,” Miki noted.
Following are five steps for building an online cognitive behavioral therapy program.
1. Define Your Audience
As with any program, it’s important to identify your users. An online CBT program can be aimed at all employees (focusing on prevention, resilience and overall mental fitness), specific cohorts (e.g., employees on leave, focusing on returning to work with the necessary stamina and skills), or both.
All programs will emphasize the need for individuals to build their own toolbox to manage stress, Miki noted, and may feature interactive exercises and educational videos to teach strategies for reducing worry, anxiety and sadness. BCTF found success through getting users involved in creating course content and structure and tailoring the program to its audience.
2. Increase Accessibility
“CBT needs to fit into an employee’s life and, in our increasingly connected, fast-paced world, many employees perceive that they are too busy to take the time for themselves, even if taking that time could improve their overall well-being,” write Heather Kaufman and Lucy Turowicz in “Mental Health and the Evolving Workplace” in the September/October 2018 issue of Plans & Trusts. Kaufman and Turowicz point out that online CBT can allow employees to fit therapy into their schedules, potentially increasing program usage. To take advantage of this ability, consider making the program available 24/7, on mobile and desktop devices, at low or no cost, and to a wide range of members.
Challenges to in-person therapy include financial and geographic constraints. By creating a program that can help hundreds or even thousands of members, online cognitive behavioral therapy can potentially reduce financial constraints through economies of scale. Similarly, geographic constraints can be reduced by allowing users in rural areas or with transportation issues to access the program from work as well as from home.
3. Overcome the Stigma
A challenge for any program can be the stigma attached to mental health disorders. Kaufman and Turowicz note that online programs can allow users to seek help discreetly, in a location and time of their choosing.
“Having an online program is a safe place where people can access it in the privacy of their own home,” Miki said. He also pointed to the benefits of programs that allow members to anonymously share their thoughts, stories and progress.
Organizations also may want to market the program to all employees, so that people feel included rather than targeted, and use terms like coaching and building skills for people who may be wary of therapy or counseling.
4. Communicate the Program
BCTF experience shows that communications benefit from variety. Organizations should consider using member e-mails, newsletters, employee meetings, workplace conferences, lunchtime presentations and more to promote and reinforce the program. Last May, BCTF offered mental health challenges, with small activities that provided opportunities for people to learn about and build upon new skills each week. These activities also served as a reminder of the program for new and returning users.
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5. Measure Effectiveness
An optimal program should be able to measure aggregate and individual scores (e.g., based on symptom reduction, productivity, work functioning) and then tailor its components to members based on their functions or abilities. Evidence-based mental health assessments and reflection exercises can help users track their own progress. Metrics also can change over time, as has happened with BCTF, which currently focuses on improvements in function and mental health based on self-assessment scores.
Is an online cognitive behavioral therapy program right for your organization?
As Kaufman and Turowicz note, mental health disorders and their associated health care costs are on the rise, and employers are searching for alternative, accessible and cost-effective methods of mental health treatment.
Organizations that build an effective online CBT program can potentially improve individual worker health and reduce the cost of absences due to mental health by reaching more employees, providing greater access and helping workers more quickly return to productive health.
Robbie Hartman, CEBS
Editor, Publications for the International Foundation