The Basic Idea
Cognitive Behavioral Therapy, or CBT, is a therapeutic treatment built on three main ideas:
- 1) cognitive activity influences behavior
- 2) cognitive activity can be monitored and changed
- 3) behavioral change can be achieved by facilitating cognitive change1
CBT can help with PTSD, OCD, and anxiety disorders.2 It’s an effective way to address a variety of mental health issues - potentially even more effective than medication or other forms of therapy.3
Through exercises agreed upon by the patient and their practitioner, CBT stresses helping people become their own therapists by developing an array of coping skills to use when symptoms arise.3
Self-guided CBT, available through apps or online, is a viable and effective alternative to traditional in-person CBT. Digital CBT takes advantage of our increasing inclination to search out health information on personal devices.4
Internet-based CBT, or iCBT, is as effective as in-person sessions if the therapist guides the curriculum.5 However, self-guided interventions are not as effective as guided programs. 6–8 As of 2017, there were an estimated 10,000 mental health apps on the market.9
Theory, meet practice
TDL is an applied research consultancy. In our work, we leverage the insights of diverse fields—from psychology and economics to machine learning and behavioral data science—to sculpt targeted solutions to nuanced problems.
In addition to creating apps, researchers have made significant strides in incorporating CBT into virtual reality (VR) or augmented reality (AR) applications.
Let’s take one of the most common phobias: arachnophobia.10 Phobias benefit from exposure therapy, a scenario in which psychologists safely “expose” the patient to the object of their fears in a psychologically and physically safe environment.11 But getting spiders into a safe environment can be difficult because of high costs, lack of available spiders (where do they find them anyway?), or high refusal rates from patients.10
Enter AR and VR:
- AR is used exclusively from one’s smartphone, whereas
- VR requires the user to wear glasses, although both represent stimuli in a 3-D environment.
Virtual experiences allow the practitioner to choose the number and size of spiders, while also giving the patients a chance to experience the spider as if it were real.
CBT apps are also conducive to implementing Stepped Care. If a sufferer of arachnophobia would benefit from an increased level of care (exposure therapy), AR and VR provide easy access to additional resources.
CBT-powered AR and VR can be used to help treat a variety of fears, from heights to specific anxiety disorders. Researchers are just beginning to investigate the potential of CBT apps, so its reach is likely to grow in the future.
The Behavioral Science
One caveat about using CBT apps is that its success depends heavily on the user’s motivation and commitment.
Treatment for a maladaptive mental health condition requires patients to be willing and devoted to the cause, traits that can be difficult even for neurotypical or mentally-well patients.2
Additionally, hyperbolic discounting can contribute to users’ lack of motivation in using CBT apps. Our general tendency toward prioritizing present gains (e.g. scrolling on your phone for instant gratification) over future gains (e.g. a CBT app) pushes us from opting into self-help applications over games, television, or social media.
CBT apps can benefit users by being as personalized as possible - a key factor in the demonstrated success of CBT. Personalization can also help address hyperbolic discounting by making practice more engaging.
Hikai is an AI-powered mental health institute. Firms use its services to gauge employee wellbeing through email-based surveys. After being surveyed, employees are then sent personalized CBT training through chatbots.
Hikai approached The Decision Lab to develop a tool that takes advantage of AI, CBT, and user engagement techniques that would increase employee engagement in the workplace.
Upon conducting a literature review on CBT, AI, and more specifically - AI-powered chatbots, we created new scripts, personalized training, and templates for email check-ins that ultimately resulted in a 71% improvement in engagement amongst pilot participants. Further, we created a way for managers to monitor their employees’ well being via a dashboard.
You can find a link to the case study here.
1. Dobson, K. S. (Ed.). (2009). Handbook of Cognitive-Behavioral Therapies, Third Edition (Third edition). The Guilford Press.
2. Rathbone, A. L., Clarry, L., & Prescott, J. (2017). Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review. Journal of Medical Internet Research, 19(11), e8598. https://doi.org/10.2196/jmir.8598
3. What is Cognitive Behavioral Therapy? (2017, July). American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
4. Silver, L., & Huang, C. (2019, August 22). 1. Social activities, information seeking on subjects like health and education top the list of mobile activities. Pew Research Center: Internet, Science & Tech. https://www.pewresearch.org/internet/2019/08/22/social-activities-information-seeking-on-subjects-like-health-and-education-top-the-list-of-mobile-activities/
5. Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. https://doi.org/10.1080/16506073.2017.1401115
6. Berger, T., Hämmerli, K., Gubser, N., Andersson, G., & Caspar, F. (2011). Internet-based treatment of depression: A randomized controlled trial comparing guided with unguided self-help. Cognitive Behaviour Therapy, 40(4), 251–266. https://doi.org/10.1080/16506073.2011.616531
7. Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., Littlewood, E., Andersson, G., Christensen, H., Klein, J. P., Schröder, J., Bretón-López, J., Scheider, J., Griffiths, K., Farrer, L., Huibers, M. J. H., … Cuijpers, P. (2017). Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry, 74(4), 351–359. https://doi.org/10.1001/jamapsychiatry.2017.0044
8. Wells, M. J., Owen, J. J., McCray, L. W., Bishop, L. B., Eells, T. D., Brown, G. K., Richards, D., Thase, M. E., & Wright, J. H. (2018). Computer-Assisted Cognitive-Behavior Therapy for Depression in Primary Care: Systematic Review and Meta-Analysis. The Primary Care Companion for CNS Disorders, 20(2), 17r02196. https://doi.org/10.4088/PCC.17r02196
9. Torous, J., & Roberts, L. W. (2017). Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. JAMA Psychiatry, 74(5), 437–438. https://doi.org/10.1001/jamapsychiatry.2017.0262
10. Toffolo, M. B. J., Fehribach, J. R., van Klaveren, C. P. B. J., Cornelisz, I., van Straten, A., van Gelder, J.-L., & Donker, T. (2022). Automated app-based augmented reality cognitive behavioral therapy for spider phobia: Study protocol for a randomized controlled trial. PloS One, 17(7), e0271175. https://doi.org/10.1371/journal.pone.0271175
11. What Is Exposure Therapy? (2017, July). American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy