No abstract

To increase access to evidence-based care, people with depression and anxiety in a Canadian community hospital were offered internet-delivered CBT (iCBT) or in-person CBT. The iCBT outpatients had a lower attrition rate with similar symptom reduction. Our results suggest that other clinics and hospitals could use iCBT to facilitate care.

Mental disorders are disabling and common. Depression, for example, has greater global burden of disease than any physical disorder, and almost a third of people will experience some form of mental disorder in their lifetime. The effectiveness of psychological interventions is well established. Cognitive Behavioral Therapy is particularly effective for mood and anxiety disorders. But CBT is demanding of time and resources, partly explaining its limited availability, even in public systems. More and more people have access to the Internet and smartphones, even in the developing world. Internet therapies (including smart-phone apps) have been developed, offering CBT. Can technology help with access to CBT? In this chapter, we will look at the effectiveness of iCBT for several illnesses, based on new evidence from recent randomized controlled trials and meta-analyses, noting that while there is evidence for this therapy, not all programs have the same results. We consider iCBT in the real world, by looking at some popular apps and websites, including MoodGYM, and also present a case from The Scarborough Hospital (where we implemented a free-at-the-point-ofuse iCBT program), demonstrating how it can be applied in an outpatient setting. We also present the current strengths and limitations associated with iCBT. Finally, we consider future directions for this field, considering chatbots and the possibilities with Artificial Intelligence.

Abstract"cross Western countries, more than a third of people will have a mental health disorder over their lifetime mood and anxiety disorders are the most common. The effectiveness of psychological interventions is well established. Cognitive "ehavioural Therapy C"T , for example, is as effective for mild and moderate anxiety as medications combined psychopharmacology and C"T is superior to either modality alone, suggesting a synergistic effect. However, C"T requires a major investment of time and resources. Thus, in public systems, C"T has limited availability and is subject to long waiting times primary-care physicians and psychiatrists may not offer C"T.Can technology address the deficiency of psychological interventions for mental illness? Internet therapies including smart phone apps have been developed, offering C"T and other psychological interventions. In this chapter, we focus on Internet-assisted C"T IC"T .IC"T allows patients to receive ongoing C"T with easier and quicker access, at reduced cost, and with increased convenience over traditional C"T. We review evidence from randomized trials and meta-analyses, which strongly support the use of IC"T in clinical practice, especially in combination with ongoing therapist support.We consider government experimentation with IC"T, with a particular focus on "ustralia. We also present a case demonstrating the clinical application of IC"T.Finally, with an eye to the future, we will look at potential research questions.

The use of complementary and alternative medicine C"M therapies is becoming an increasingly popular treatment option for anxiety disorders in adults and youth. Parents often are reluctant to use antidepressants due to fear of potential side effects. Youth are often unwilling to participate in cognitive behaviour therapy C"T or it is not readily available. Practitioners are not always knowledgeable or open to considering C"M therapies for their patients. This chapter will review the definition of C"M, prevalence of C"M use, its safety and effectiveness and finally its practical applications. Four case studies are discussed in which practitioners were open to the use of C"M and collaborated successfully with parents of youth with anxiety disorders. Literature review is presented for use of vitamin D, melatonin, acupuncture, acupressure and craniosacral therapy.