scholarly journals Is the Automation of Digital Mental Health Ethical? Applying an Ethical Framework to Chatbots for Cognitive Behaviour Therapy

2021 ◽  
Vol 3 ◽  
Author(s):  
Giovanna Nunes Vilaza ◽  
Darragh McCashin
Keyword(s):  
Mental Health ◽  
Research Policy ◽  
Behavioural Therapy ◽  
Ethical Framework ◽  
Conversational Agents ◽  
Behaviour Therapy ◽  
Face To Face ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
Mental Health Support

The COVID-19 pandemic has intensified the need for mental health support across the whole spectrum of the population. Where global demand outweighs the supply of mental health services, established interventions such as cognitive behavioural therapy (CBT) have been adapted from traditional face-to-face interaction to technology-assisted formats. One such notable development is the emergence of Artificially Intelligent (AI) conversational agents for psychotherapy. Pre-pandemic, these adaptations had demonstrated some positive results; but they also generated debate due to a number of ethical and societal challenges. This article commences with a critical overview of both positive and negative aspects concerning the role of AI-CBT in its present form. Thereafter, an ethical framework is applied with reference to the themes of (1) beneficence, (2) non-maleficence, (3) autonomy, (4) justice, and (5) explicability. These themes are then discussed in terms of practical recommendations for future developments. Although automated versions of therapeutic support may be of appeal during times of global crises, ethical thinking should be at the core of AI-CBT design, in addition to guiding research, policy, and real-world implementation as the world considers post-COVID-19 society.

Depression, Anxiety and Self-esteem: A Clinical Field Study

2002 ◽  
Vol 19 (2) ◽  
pp. 112-120 ◽  
Author(s):  
Denise A. Nisbet Wallis
Keyword(s):  
Mental Health ◽  
Therapy Group ◽  
Self Esteem ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
Behaviour Therapy ◽  
Central Coast ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour

AbstractThe Cognitive Behavioural Therapy Group Program at Central Coast Mental Health Specialty Clinics includes treatments for generalised anxiety disorder, panic disorder and depression. This study provides empirical validation for hypotheses developed in clinical controlled studies; that is, that cognitive-behaviour therapy provided benefits in the treatment of anxiety and depression in a service setting. This would be reflected in decreases in the symptoms of anxiety and depression and increased self-esteem. Participants (N = 139) were referred to Specialty Clinics, Central Coast Mental Health Services for treatment for depression and/or anxiety in CBT groups. They were tested on the BDI, STAI and the SERS at three time points, prior to entering the group, at termination of the group and at 3-month follow-up. Depression and anxiety symptoms decreased and self-esteem increased between pre- and post-group and the trends continued to 3-month follow-up.

scholarly journals Manualised Cognitive Behaviour Therapy for Anorexia Nervosa: Use of Treatment Modules in the ANTOP Study

2018 ◽  
Vol 7 (11) ◽  
pp. 398 ◽  
Author(s):  
Gaby Resmark ◽  
Brigid Kennedy ◽  
Maria Mayer ◽  
Katrin Giel ◽  
Florian Junne ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Secondary Analysis ◽  
Self Esteem ◽  
Behavioural Therapy ◽  
Behaviour Therapy ◽  
Duration Of Illness ◽  
Cognitive Behavioural ◽  
Outpatient Intervention ◽  
Cognitive Behaviour ◽  
Pros And Cons

Standardised treatment manuals facilitate therapy planning and enhance comparability for research purposes. Within the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, the largest multisite outpatient intervention trial in anorexia nervosa (AN) to date, manualised enhanced cognitive-behavioural therapy (CBT-E) was offered as one treatment modality. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Homework worksheets were provided, to ensure the transfer of therapeutic improvements to daily life. This study investigated the use of modules and worksheets in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log-sheets (n = 2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as that between use of module and duration of illness, were examined. The most commonly used module was Motivation. In patients with longer illness duration, the module Self Esteem seemed to be particularly important. The worksheet Scales, balancing the pros and cons of AN, was prioritised by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self esteem stabilisation, should be of focus.

MULTIPLE ACCESS POINTS AND LEVELS OF ENTRY (MAPLE): ENSURING CHOICE, ACCESSIBILITY AND EQUITY FOR CBT SERVICES

2000 ◽  
Vol 28 (4) ◽  
pp. 379-391 ◽  
Author(s):  
Karina Lovell ◽  
David Richards
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Developed Countries ◽  
Evidence Base ◽  
Health Problems ◽  
Behaviour Therapy ◽  
Face To Face ◽  
Cognitive Behaviour ◽  
Traditional Service ◽  
Common Mental Health Problems

Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.

scholarly journals Evaluation of an Australian primary care telephone cognitive behavioural therapy pilot

2014 ◽  
Vol 20 (1) ◽  
pp. 62 ◽  
Author(s):  
Bridget Bassilios ◽  
Jane Pirkis ◽  
Kylie King ◽  
Justine Fletcher ◽  
Grant Blashki ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Care Program ◽  
Pilot Project ◽  
Behavioural Therapy ◽  
Face To Face ◽  
Cognitive Behavioural ◽  
Minimum Dataset

A telephone-based cognitive behavioural therapy pilot project was trialled from July 2008 to June 2010, via an Australian Government-funded primary mental health care program. A web-based minimum dataset was used to examine level of uptake, sociodemographic and clinical profile of consumers, precise nature of services delivered, and consumer outcomes. Key informant interviews with 22 project officers and 10 mental health professionals elicited lessons learnt from the implementation of the pilot. Overall, 548 general practitioners referred 908 consumers, who received 6607 sessions (33% via telephone). The sessions were delivered by 180 mental health professionals. Consumers were mainly females with an average age of 37 years and had a diagnosis of depressive and/or anxiety disorders. A combination of telephone and face-to-face sessions of 1 h in duration were conducted, delivering behavioural and cognitive interventions, usually with no cost to consumers. Several implementation issues were identified by project officers and mental health professionals. Although face-to-face treatment is preferred by providers and consumers, the option of the telephone modality is valued, particularly for consumers who would not otherwise access psychological services. Evidence in the form of positive consumer outcomes supports the practice of multimodal service delivery.

The Cost of Child Behaviour Therapy: The First Step to Demonstrating Cost-effectiveness

1996 ◽  
Vol 13 (2) ◽  
pp. 124-135 ◽  
Author(s):  
Mervyn Jackson ◽  
Ray Wilks
Keyword(s):  
Cost Effectiveness ◽  
Total Duration ◽  
Clinical Problem ◽  
Treatment Programs ◽  
Future Research ◽  
Behaviour Therapy ◽  
Face To Face ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
The Cost

There has been extensive debate over the last three decades about which professional groups should receive government-funded rebates in the mental health field. Cognitive-behaviour therapists appear to be in the best position to demonstrate clinical efficacy, but have failed to demonstrate cost-effectiveness of cognitive-behaviour therapy. There is a need to demonstrate the cost of behaviour therapy as the first step in determining the cost-effectiveness of behaviour therapy compared to the traditional (medical-based) interventions. Using archival data from a university-based psychology clinic specialising in cognitive-behavioural interventions with child and adolescent problems, the present research determined the cost of successful treatment programs with the clinic's major referral areas: nocturnal enuresis, behaviour management, and education-based problems. Analysing 77 cases, it was found that there were significant between group differences in the number and total duration of face-to-face interviews, in the number of other contacts between therapist and client, in total therapist time, and in the estimated average cost of cases. There emerged different treatment patterns for each clinical problem, and these were reflected in costing. A number of research and methodological issues are explored. Implications for future research on cost-effectiveness and the subsequent collection of comparative data across clinics and a variety of clinical problem areas are discussed.

Cognitive Behaviour Therapy: Standards for Training and Clinical Practice

2006 ◽  
Vol 23 (4) ◽  
pp. 227-238 ◽  
Author(s):  
◽  
Julie Barrington
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Mental Health Problems ◽  
Psychological Treatment ◽  
Public Funding ◽  
Public Mental Health ◽  
Behavioural Therapy ◽  
Clinical Psychologists ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

AbstractThe purpose of this article is to open discussion on the appropriate standards for training and practice in cognitive behavioural therapy (CBT) for clinical psychologists. CBT has in recent years become increasingly popular as a brief and effective psychological treatment for mental health problems. Public funding has become available for the provision of CBT for a prescribed number of sessions to people diagnosed with specific psychiatric disorders, and there has been an increasing shift in public mental health services toward more short-term and structured episodic care interventions, many of which are CBT-based. There has also been a corresponding increase in health professionals seeking CBT training and offering psychological services described as CBT. However, there is a lack of formal nationally agreed standards for clinical psychologists in relation to training and practice in CBT, and ethical concerns have been raised about the provision of ‘stand-alone’ brief training to professionals who do not have an undergraduate psychology degree and hence may not have an understanding of the theory and research that underlies CBT. Issues raised in this article include training and practice considerations such as levels of competence, diversity and complexity of CBT, treatment length, ethical considerations and barriers to best practice.

scholarly journals Cognitive Behavioural Therapy for Japanese Children and Adolescents with Anxiety Disorders: A Pilot Study

2012 ◽  
Vol 40 (3) ◽  
pp. 271-285 ◽  
Author(s):  
Shin-ichi Ishikawa ◽  
Naoyasu Motomura ◽  
Yasuo Kawabata ◽  
Hidetaka Tanaka ◽  
Sakie Shimotsu ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Behavioural Therapy ◽  
Behaviour Therapy ◽  
Japanese Children ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
Self Talk ◽  
Future Challenges

Background: Thirty-three Japanese children and adolescents diagnosed with an anxiety disorder participated in individual or group Cognitive Behaviour Therapy (CBT) that was modelled after evidence-based intervention programs developed in Western countries. Method: The treatment consisted of: (a) building rapport and education; (b) identifying emotions and recognizing cognitive self-talk; (c) challenging anxious self-talk; (d) developing an anxiety hierarchy and in vivo exposures; and (e) planning for future challenges. Results: Three months following treatment, 20 of the 33 children and adolescents (60.91%) no longer met criteria for their principal anxiety disorders and 16 (48.48%) were free from all anxiety disorders. Self-reported anxiety, depression, and cognitive errors also decreased significantly from pre- to post-treatment and these gains were maintained at 3-month follow-up. For the most part, similar outcomes were found in both the group and individual formats of CBT. Conclusions: This study provides preliminary support for the transportability of CBT in both an individual and group format to Japan.

Cognitive Behaviour Therapy for Obsessive-compulsive Disorder

2017 ◽  
Author(s):  
Victoria Bream ◽  
Fiona Challacombe ◽  
Asmita Palmer ◽  
Paul Salkovskis
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Family Involvement ◽  
Cognitive Behaviour Therapy ◽  
Behavioural Therapy ◽  
Illustrative Case ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour

Obsessive-compulsive disorder (OCD) can be a very disabling and distressing problem. Cognitive behavioural therapy (CBT) has been shown to be very effective in helping people to overcome OCD. OCD is a highly heterogeneous disorder, often complicated by contextual factors, and therapists are often left wondering how to apply their knowledge of treatment to the particular problems as they face them in clinical practice. This book guides the reader through understanding the background to and principles of using CBT for OCD in a clear practical ‘how to’ style. It also elucidates the particular challenges and solutions in applying CBT for OCD using illustrative case material and guidance on formulation-driven intervention. The book also addresses commonly occurring complexities in the treatment of OCD; for example, working with comorbidity, perfectionism, shame, and family involvement in symptoms. Throughout the book, tips are provided on receiving and giving supervision to troubleshoot commonly encountered problems. This book provides a guide to improved practice for clinicians at all levels of experience.

ASSESSING THERAPIST ADHERENCE TO COGNITIVE-BEHAVIOUR THERAPY FOR PSYCHOSIS

2002 ◽  
Vol 30 (3) ◽  
pp. 329-339 ◽  
Author(s):  
Mike Startup ◽  
Mike Jackson ◽  
Emma Pearce
Keyword(s):  
Rating Scale ◽  
Collaborative Study ◽  
Preliminary Evidence ◽  
Behavioural Therapy ◽  
Future Research ◽  
Behaviour Therapy ◽  
Therapist Adherence ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
Adherence Scale

Recently, several RCTs have provided preliminary evidence that cognitive-behavioural therapy (CBT) is effective in the treatment of people suffering from schizophrenia. However, none of these trials has provided complete demonstrations of therapist adherence. Since no suitable scale existed already, the authors devised the Cognitive Therapy for Psychosis Adherence Scale (CTPAS). The main aim of the present research was to test whether the 12 items of this scale could be rated reliably. Ratings were made on 29 sessions of CBT for schizophrenia by two raters independently and their agreement was found to be at least adequate on 10 of the items of the CTPAS. Ratings were also made on relevant items of the Collaborative Study Psychotherapy Rating Scale and agreement was found to be more than adequate for three factor-based subscales derived from these items. The results suggest therapist adherence to CBT for psychosis can be rated reliably and that the CTPAS is likely to be useful in future research on this form of treatment.

Group CBT for psychosis in acute care: a review of outcome studies

2015 ◽  
Vol 8 ◽  
Author(s):  
Mary Owen ◽  
Tom Speight ◽  
May Sarsam ◽  
William Sellwood
Keyword(s):  
Randomized Controlled Trials ◽  
Behavioural Therapy ◽  
Psychotic Symptoms ◽  
Controlled Trials ◽  
Behaviour Therapy ◽  
Post Intervention ◽  
Randomized Controlled ◽  
Affective Symptoms ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour

AbstractThere is evidence that group cognitive behavioural therapy for psychosis (CBTp) is an effective treatment, but much of this research has been conducted with outpatient populations. The aim of this review was to determine the utility of group CBTp for inpatients. We systematically searched Scopus, Web of Science and EBSCO electronic databases to identify relevant research. We reviewed the resulting articles and included those which had been conducted with inpatients, with symptoms of psychosis, using cognitive behaviour therapy, delivered in a group format. Fourteen articles relating to ten studies were identified. Two were randomized controlled trials; two were cohort studies and the rest were pre-/post-intervention studies. There was considerable heterogeneity between the studies and all had methodological limitations. The findings suggest positive trends towards the reduction of distress associated with psychotic symptoms, increased knowledge of symptoms, decreased affective symptoms and reduced readmissions over several years. However, there is currently not enough evidence to draw any strong conclusions regarding the utility of group CBTp for inpatients due to the small number of studies and limitations in quality and generalizability. Therefore, this review indicates the need for further research, particularly large, methodologically rigorous, randomized controlled trials.

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