What Is iCBT?

Internet-based cognitive behavioural therapy is fast becoming a key element of virtual health care

By Bill Zolis

I don’t think I’ve ever seen a new idea in health care, and one that has such a big impact on employee benefits, take off quite as fast as internet-based cognitive behavioural therapy, or iCBT. I think it’s a case of the right technology being in the right place at the right time.

CBT itself, whether it’s Internet-based or face-to-face in a professional’s office, is not new. It has for many years been the first-line treatment for most of the mental health issues that send people to their doctors’ offices, such as anxiety, depression, obsessive-compulsive behaviours and stress.

And CBT is not just “talking about your problems.” It is a structured process of helping people to understand how some of the things they think and feel and believe may be mistaken or out of proportion in ways that end up being destructive to their well-being.

So where does the Internet-based delivery of CBT fit into the picture?

First, there is a huge demand for mental health services. According to numbers I’ve been able to find, at least 40 percent of visits to a doctor’s office or Emergency Department are mental-health related. Add wait-times to the picture – days to see a family doctor, months to get an appointment with a psychiatrist – and it becomes pretty obvious that there is a great deal of pent up demand.

Second, it’s becoming clear that virtual healthcare (as I talked about in a previous blog) is a very effective way of delivering CBT. Figures I’ve seen from the National Institutes of Health suggest that a majority of users of the service report a significant reduction in symptoms, and that most users report being happy with the experience.

Things are evolving pretty rapidly in the field of iCBT, but there appear to be several different models, and choosing the best approach will, of course, vary from one user to the next. (One thing all of these programs tend to stress is that iCBT is not for emergency mental health issues, such as severe depression or suicidal thoughts – which require an immediate response, like going to the nearest Emergency Department.)

– Some programs are strictly on-line. You log in, provide information about yourself, and work through a self-paced series of elements.

– Many programs start with a live consultation and assessment, followed by independent work recommended by the consultant. There may or may not be touch points along the way to speak live with the professional.

– Other programs consist of a series of live, on-line virtual consultations with a CBT professional.

I think there are a lot of reasons why iCBT is taking off so rapidly. Major insurers have been making iCBT available to benefits plan sponsors since 2018, and it has become a key component of many benefits plans. In Ontario, the government added free on-line mental health consultations for members of the public as part of its COVID response plan in 2020. And private insurers are adding iCBT to their line of consumer packages.

So why is everyone coming on board? Like I said at the beginning, it’s a case of having the right product, at the right time, in the right place. (And the “right place,” especially during a pandemic lockdown in a work-from-home world, is safe at home.)

– Effectiveness. The bottom line driving the rise of virtual health care and iCBT, is that there is an impressive and growing body of research that shows that it can be very effective. The NIH study I cited above goes so far as to say that symptom reduction is in line with that achieved in face-to-face treatment scenarios.

– Employee retention. We’ve talked about the “well workplace” in this blog many times, and I keep coming back to the role of a good benefits program. Providing benefits that people will use, and that are effective in supporting their wellness, will have positive effects up and down the line – employee retention, reduced absenteeism, better morale.

– Reach. We know that a great many people – although I couldn’t find any research on numbers – just wouldn’t go to a doctor for any reason, if they could avoid it. But iCBT, and virtual health care in general, are a different ballgame entirely.

– Capacity. With 40 percent of doctor visits being for mental health issues, iCBT adds more resources that may relieve some of the demands on the medical system – one of the reasons governments are joining the trend (and not standing in the way of privately funded access to health care in this case).

– Secondary benefits. The American Psychological Association – which strongly supports iCBT – suggests that 70 percent of doctors visits are actually mental health related in some way. Or, to put it another way, that better and earlier treatment of mental health issues would result in a large reduction in other health issues.

– Cost. On-line treatment of mental health issues is simply much cheaper, regardless of who is paying the bill, than a series of doctor visits or hospitalization.

– Accessibility. Anyone – and especially any employee with iCBT and virtual healthcare as part of their benefits package – can access care without long wait times, and without taking a half day off for each doctor visit.

– Removing barriers. Virtual healthcare solutions, such as iCBT, go a long way in removing the stigma that many people still feel is associated with seeking help for mental health issues. People who are reluctant to seek help find iCBT, from their own homes on their own schedule, much less stressful.

– Ease of use. With iCBT, there is no need to make an appointment, travel to a doctors office, wait in the waiting room – and be hurried out again when their allotted time is up.

Yes, the pandemic and the lockdown and the surprising success of working from home have given virtual services a big boost and an opportunity to prove themselves. I think we’ll be hearing a great deal more about iCBT and virtual healthcare in general. It’s here to stay.

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I’ve come across several very interesting presentations in the last couple of weeks, and I thought I would share them with you. I think you will find them as thought-provoking as I did.

Penmore education series: Mental Wellness in the Workplace Webinar

Benefits Alliance presents Dr. Robyne Hanley-Dafoe, on resiliency and workplace wellness. Click here to watch the presentation.

Ontario Shores Foundation 6th Annual Mental Health Conversation keynote speaker, Kevin Frankish. Click here to listen.

Dr. Mike Evans: 23 and 1/2 hours: What is the single best thing we can do for our health? Watch YouTube video here.

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I really appreciate comments, ideas, suggestions or just observations about the blog or any other topics in benefits management. I always look forward to hearing from readers. If there’s anything you want to share, please email me at bill@penmore.com.

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