Almost one half of Canadians (49%) suffering from depression or anxiety will not seek help . Common barriers to treatment include long waitlists, geographic distance, insufficient number of healthcare providers, and perceived stigma. However, with the exponential advances in technology over the last few decades, internet-based interventions have been proposed as one solution to help bridge the treatment gap.
Dr. Peter Farvolden is a Founding Clinical Director of CBT Associates, a leading Toronto-based psychology practice, and the Clinical Lead of BEACON, a digital therapy platform that delivers internet-based cognitive behavioral therapy (iCBT). He also holds faculty appointments at the University of Toronto, University of Waterloo and Ryerson University. I had a conversation with Dr. Farvolden to learn more about BEACON and iCBT.
Could you explain what iCBT is and how it was developed?
The way we describe it is therapist-assisted internet-delivered CBT (TAiCBT). There's about forty years of research on the effectiveness of CBT for mood and anxiety. There’s also been a long history of research on figuring out what minimal intervention is—how to take the effective components of CBT and deliver them in the most efficient way. With iCBT, there’s about twenty years of research with over a hundred randomly controlled trials in depression and anxiety. With all this data, we have been able to draw conclusions about who it would work for, how long treatment should last for, and what components of CBT would be most effective for mood and anxiety disorders.
What steps are involved in accessing online therapy through BEACON?
People start by completing a thorough online assessment, which is the first step in a stepped-care model. The assessment is then interpreted by a therapist, and then, if appropriate, they’re “onboarded” to BEACON therapy. Currently, if they have depression, generalized anxiety, panic disorder, social anxiety, or post-traumatic stress disorder, we can onboard them to a protocol driven treatment. If iCBT is not appropriate, they’re directed toward other resources.
After registration, they will receive their first message from the BEACON therapist that reviewed their initial assessment. After which they will receive new material on roughly a weekly basis. The therapy introduces clients to ideas and techniques that are part of CBT. The client works through the activities with the guidance of a dedicated therapist who will give them feedback on their progress. On average, effective treatment occurs in about eight weeks, but if needed, we can keep them onboard BEACON therapy for up to twelve weeks.
In our model, all of the therapy occurs through messaging. There are no scheduled phone or video sessions. You message your therapist whenever you wish, and your therapist responds within 1-2 business days.
What advantages and disadvantages does BEACON provide for the client?
BEACON helps to overcome barriers to accessing effective evidence-based treatment. One barrier is stigma. Although people have done great work over the last ten years to reduce stigma, it’s still a significant barrier for some people to access treatment. In my experience, people will access therapy this way who would otherwise never darken the door of a psychologist. They just wouldn’t do it. It still takes quite a bit of courage to show up to the office of a psychologist.
There’s also geography; for example, a lot of people can’t take an afternoon off work every week to see their psychologist. It may take an hour to get to the office, and then an hour for the appointment, and then another hour to get back home. It becomes a three-hour thing that no one really has time for.
Another advantage is that they can do it when, where, and however they want. They can do a lot of it intensely over a short period of time, or they can do it more stretched out over the twelve weeks. We certainly tell people that the more they engage with us, and the more effort they put into it, the better the chances are that this is going to be helpful.
The disadvantage is that some people would prefer face-to-face therapy. They would prefer to have that interaction. At first, people might say that iCBT would not work for them, but when we start to tell them to look at the research that says that it’s just as effective as face-to-face treatment, their openness to iCBT increases.
What advantages and disadvantages does BEACON provide for the therapist?
For therapists it provides several advantages. One of them is that the educational part of CBT can be done by the platform. For example, if I’m meeting with a client who has panic disorder, one of the things I have to do is explain how the panic cycle works. I have had clients over the last several years who asked, “Why don’t you have a video on this? Why am I paying you to do a lesson on panic disorder?” A platform can probably do a better job giving out information, and in this way, the therapist doesn't have to be repeating information. This frees up more time to do therapy with the client.
Additionally, the idea of weekly one-hour sessions is a convention based on how traditional psychotherapy is done. For a lot of people, it might be more useful to have three or four briefer interactions with your therapist every week. For example, if a client is given a CBT assignment, they might forget what they were supposed to do. With the conventional once-a-week psychotherapy format, the client would have to wait until the next week to say to their therapist that they forgot what to do for their assignment. With the BEACON format, if you don't understand something, you can get feedback faster.
The other huge advantage for therapists is that they have time to think. In traditional psychotherapy, if you're sitting in a room with somebody and having an interaction, you're unable to pause time and consider what you're going to say next. With this platform, you have time to consider what you're going to say next. Not only that, they have time to consult with colleagues to get their input on how to treat a client.
A disadvantage is that you can't see the person's face and their emotions, because normally we get information from people from the tone of their voice and all the non-verbal cues. If you're messaging, you don't have access to that information. However, there is a science developing of how to do therapy through messaging in the most effective way. Researchers are looking at message histories to find out what makes for effective psychotherapy when using this modality.
What does the future have in store for BEACON?
I think the future is building out our library of protocols. Today we are treating mild-to-moderate depression, anxiety and PTSD; we are in process of developing more protocols to provide care for other conditions that are treatable through CBT. The future also involves including relapse prevention. Typically, in psychotherapy, we treat somebody until they're well enough, but then we stop treatment and don’t follow up. I think in terms of maintaining wellness, the future is that somebody can come on the platform and be treated, and then we'll continue to follow them in order to help them stay well.
 Canadian Mental Health Association. (2019). Fast Facts about Mental Illness. Retrieved from: https://cmha.ca/about-cmha/fast-facts-about-mental-illness
Edited by Celina Liu & Rachel Dragas
Featured in Issue 4: Substance Abuse