What are low-intensity CBT treatments? - Chapter 22

What is this chapter about?

While there are several factors that hinder young people's access to CBT (such as misdiagnoses and stigmas), the biggest problem is that the demand for CBT for children is much greater than the availability of therapists. As a result, only a small proportion of needy children receive the necessary help. Low-intensity treatment methods could increase accessibility.

Why should we use low-intensity CBT treatment methods?

Low-intensity CBT treatment methods increase accessibility by improving cost-effectiveness, reducing geographic barriers, and/or reducing the treatment burden for patients. Thus, so-called "low intensity CBT", as opposed to "high intensity CBT" – contains at least one of the following characteristics: less input from the therapist per patient, integrating communicative technologies into CBT treatment, and/or transferring the CBT by therapists trained in low-intensity therapies.

Which low-intensity CBT treatment methods exist?

Four low-intensity CBT treatment methods will now be briefly discussed: self-help interventions, group-based CBT, telephone-based CBT and video calls.

Self-help interventions

Self-help interventions are treatments that can be performed independently, or with minimal support from a therapist. These can include books and manuals, audio recordings, DVDs or computerised therapies. The following can be created with regard to self-help interventions: pure self-help (PSH) or guided self-help (GSH). In PSH, there is no involvement of the therapist at all. In GSH, the therapist can offer support or guidance during face-to-face sessions, but also through phone or e-mail. Most of self-help treatments are based on the CBT. More and more studies argue that such treatments are clinically effective and also cost effective. In general, studies on the effectiveness of such programs in children and adolescents can be broken down into programmes that 1) are directly aimed at the child, and 2) programmes to help the child but directed at the parents.

Although little research has been done on the effectiveness of GSH, studies suggest that this is a promising method for adolescents with mental health problems. According to Schmidt's and colleagues’ RCT study(2007), GSH is one step ahead in terms of accessibility, treatment costs and outcome compared to family therapy. According to other studies, GSH is effective in managing mental health problems, with a medium effect size. Young people often have a very positive attitude towards such self-help methods.

Significantly more research has been conducted onto the self-help methods in which parents are the group that are focused on when the child exhibits disruptive behavior. Both GSH and PSH can then be effective to reduce disruptive behaviours of the child. Behavioural parenting programs are the most powerful interventions for families, especially when the child is under 9 years of age. Positive interactions between parent and child are stimulated, and inconsistent or compulsive parenting styles are addressed.

In the context of anxiety disorders, PSH does show potential for families with anxious children. What is more definitive is the effectiveness of GSH in treating an anxiety disorder in the child (Creswell and colleagues, 2010).

Group-oriented CBT

Over the last ten years, a lot of research has been conducted to evaluate group-oriented CBT. Group-oriented CBT is promising, especially in the treatment of anxiety disorders. According to Manassis and colleagues (2012), group-oriented CBT is even as effective as individual CBT in treating anxiety disorders, but more research is needed to really say something about this relative effectiveness. A side note is the subgroup of children with social anxiety: this can be a problem within the context of group-oriented CBT. This can be solved by dedicating sessions specifically to social anxiety, and not to a heterogeneous group of anxiety symptoms. These studies do involve the parents to some extent in the treatment, since group-oriented CBT works better for anxious children when the parents are involved.

Parenting programmes are very effective in preventing behavioural disorders (see Chapter T) but also in treating them, even when offered in a group. Some studies even say that it works better if they are offered in groups (for example, Cunningham and colleagues, 1995).

Telephones and video-calls in CBT

CBT sessions over the phone, or telephone CBT, have the same structure as traditional (face-to-face) sessions. In the context of telephone CBT in parents of children with various disorders (such as ADHD, ODD and anxiety disorders) telephone CBT has been shown to be effective, and it is expected to be as effective as personal CBT! Video-calls are also effective in treating depression or anxiety disorder, according to two recent studies, including that of Storch and colleagues (2011).

What can be concluded?

There are some things that can be concluded in terms of low-intensity CBT. First of all, the amount of evidence on the efficiency, effectiveness and cost-effectiveness of parent-based interventions (interventions aimed at parents) for the treatment of behavioural disorders in their child is particularly high, as it is a relatively new area. In addition, a great deal of effort is made to develop new methods to transfer such low-intensity CBT. Finally, the therapeutic experiences of patients are still positive, especially the experiences of young people, as self-help and the new modern ways in which this can be conveyed (by telephone, videoconferencing) are easy and flexible. According to Bennett-Levy and colleagues (2010), there is a "revolution in health care" because of the emergence of these low-intensity CBT interventions.

While there are several factors that hinder young people's access to CBT (such as misdiagnoses and stigmas), the biggest problem is that the demand for CBT for children is much greater than the availability of therapists. As a result, only a small proportion of needy children receive the necessary help. Low-intensity treatment methods could increase accessibility.