As is the case in many areas of health care but perhaps most evident in the treatment of addiction, there is a tremendous gap between research and practice. In response to this issue, Dr. Carroll and her colleagues developed a computer assisted version of cognitive behavioral therapy (CBT4CBT). CBT has a strong record of efficacy across a range of substance use and psychiatric disorders. The skills-based approaches of CBT are extremely well suited to a computer-based, multimedia format. The multimedia style of CBT4CBT includes presentation of material in a range of formats including multiple videotaped examples that allow users to actually see professionally produced "movies" of people implementing CBT coping skills in realistic settings. Other examples include interactive graphics and games, verbal instructions and audio voice-overs, interactive assessments, and practice exercises(“homework”).

A recently published randomized clinical trial of CBT4CBT demonstrated its efficacy in reducing substance use in a heterogeneous group of drug and alcohol users entering a community-based outpatient substance abuse clinic. The initial findings are consistent with previous work demonstrating the efficacy of computerized versions of CBT for the treatment of depression and anxiety. Dr. Carroll's and her colleagues work on CBT4CBT extends these findings in several important ways.

While previous studies have relied predominantly on unblended patient self-reports of improvement, Dr. Carroll's team has demonstrated efficacy with biologically verified outcome indicators (urine and breath samples. They have been able to document significantly longer periods of abstinence among those using the CBT4CBT program.
They have demonstrated enduring efficacy of the CBT4CBT program, again with biologically-verified outcomes, through a six-month follow-up evaluation.
They have used independent (blind) ratings of participants’ levels of coping skills before and after treatment to demonstrate that the CBT4CBT program actually teaches the targeted coping skills (relative to standard treatment)and that acquisition of these skills contributes to the enduring effects of the program (e.g., evidence of mediation).
They have demonstrated that the program is highly cost effective, producing significant improvements in outcome at minimal cost. Thus, not only can computer-assisted programs such as CBT4CBT dramatically enhance availability and reduce costs of providing empirically validated therapies, but the level of quality control and standardization is an important strategy for understanding the mechanisms of effective behavioral therapies.

About the Speaker:
Dr. Kathleen M. Carroll graduated summa cum laude from Duke University, received her Ph.D. in clinical psychology in 1988 from the University of Minnesota, and completed her pre-doctoral training at the Yale University School of Medicine’s Division of Substance Abuse, where she was promoted to Professor in 2002. Since 1994 she has served as Scientific Director of the Center for Psychotherapy Development at Yale, NIDA’s only Center devoted to behavioral therapies research, and since 1999 she has been Principal Investigator of the New England Node of the National Institute on Drug Abuse’s Clinical Trials Network, one of the four founding centers funded in this national infrastructure.

An ISI Thompson ISI Highly Cited Researcher, Dr. Carroll is the author of over 150 peer-reviewed publications as well as numerous chapters and books. Her research has focused on the development and evaluation of behavioral treatments and combinations of behavioral therapies and pharmacotherapies, with an emphasis on improving the quality and rigor of clinical efficacy research in the addictions. Dr. Carroll received a NIH MERIT (Method to Extend Research in Time) in 2003 for her work on developing computer-assisted training in cognitive-behavioral therapy. Dr. Carroll served as President of the American Psychological Association’s Division 50 (Addictions) from 2002-2005 and received the Divisions’ Distinguished Scientific Contributions to Education and Training Award in 2005.