Reflections from the Annual Meeting of the Association of Behavioral and Cognitive Therapies (ABCT)
Written by: Margaret Anton & Nicholas Forand
As scientist practitioners now in the virtual mental health care delivery world, we know how critical it is that we stay abreast of the evidence to ensure AbleTo continues to deliver high quality clinical care. So you can imagine we were excited for this year’s Association of Behavioral and Cognitive Therapies (ABCT) meeting.
The ABCT conference is an eagerly awaited event for professionals interested in evidence-based mental health care. Experts meet to discuss the latest in cognitive behavioral therapy (CBT) at the intersection of current events and mental health. This year’s conference theme focused on Promoting Cognitive Behavioral Practice and Science in the Context of Public Health, Social Justice, Policy, Research, Practice, and Training.
The content certainly lived up to our expectations. And as both of us have recently made the transition from academia to industry, we experienced the content through a new and expanded lens, one informed by seeing what’s truly possible when it comes to delivering evidence-based care at scale.
So we wanted to share our key takeaways from the meeting and thoughts about how organizations providing evidence-based behavioral health care (like AbleTo) are poised to address many of the current challenges in mental health care that were a central part of the conversation at this year’s meeting.
1. Equity and Inclusion
Consistent with this year’s conference theme, there was a major focus on diversity and inclusion. Specifically, there was the recognition that one size does not fit all, particularly for digital behavioral health interventions. Key stakeholders from diverse groups must be included when designing and building new products to ensure they meet the expectations and needs of diverse and often underserved populations.
Speakers highlighted the need to strike a balance between fully tailored services and services that are applicable and appropriate for a wide range of populations. At our organization, we strive to include diverse perspectives in our product research and development process and evaluate the clinical impact of our programs among diverse populations. As new populations engage in our programs, we discuss potential population differences and use data to inform when to adapt and adjust business as usual.
We consistently measure our outcomes and engagement to ensure we are meeting the needs of diverse populations. Working towards diversity and inclusion in behavioral health care requires ongoing attention and care. We are continuously working towards improving the cultural sensitivity of our products and the cultural competency of our provider network to ensure the highest quality of care for the populations we serve.
2. Transdiagnostic Protocols
We were struck by how often the word transdiagnostic popped up in the conference. Transdiagnostic approaches attempt to move away from treatments for just one diagnosis and towards those that address multiple problems in a unified way. In theory, one treatment that can handle multiple problems not only helps address high rates of comorbidity, but also may improve the implementation of evidence-based care.
Training providers to deliver one intervention that can be applied broadly to diverse patient populations may be more efficient and scalable than training providers in a range of interventions for specific problems. That said, it has to be done right. Training providers in principles of behavior change rather than specific treatment manuals is a big shift from how most implementation and training efforts are currently done.
The increased flexibility offered by the transdiagnostic approach might also make it more difficult to ensure fidelity and quality. At AbleTo, our providers are already flexibly applying our protocols to meet the individual needs of their patients, and we will continue to adapt our treatment protocols to bring them up to date with the latest research. At the same time, our provider network has more than doubled in the past year, so we are laser focused on scaling our quality oversight efforts alongside and ensuring adherence to protocols that consistently deliver participant outcomes is maintained.
As new research on transdiagnostic approaches become available, we will continue to learn and adopt the best and most efficient ways to deploy this model and monitor fidelity at scale. We also aim to disseminate our observations and learnings to the clinical and scientific community so that others might also learn from our scaled experience.
3. Coaching Protocols
Digital behavioral health interventions have been a hot topic at ABCT for the past few years, and this year was no different. Indeed, the COVID-19 pandemic led to a surge of investment in and demand for digital behavioral health interventions. Although these interventions are still relatively new, we know that people engage with them more and have better outcomes if they are paired with some kind of human support or coaching. But presenters also highlighted that we still don’t know what aspects of coaching work well and why.
How much coaching is needed and for whom? Are voice calls better than text messages? Questions like these are also a routine part of our work to continuously improve and develop AbleTo’s digital interventions. Our coaches are trained in evidence-based techniques, including Motivational Interviewing, and quality is systematically reviewed. These processes contribute to the high rates of engagement we have observed relative to other products and significant reductions in depression and anxiety symptoms (Anton et al., 2021).
As we expand our digital offerings, we will seek the opportunity to test and evaluate new and possibly more effective approaches to coaching.
We know CBT works, but a major area of focus at ABCT – this year and every year – was understanding how it works. As therapists, we teach patients that they need to practice CBT skills outside of session to really learn them.
Several studies presented at the conference suggested that both homework compliance (completing the assignments) and homework quality (how well a patient did on the assignment) are associated with treatment outcomes. While many of us long believed this to be true, it was great to see research that confirmed our experience. It’s important to meet patients where they are. In order to do this, we offer multiple ways to access treatment information and complete homework. This includes leveraging technology to optimize homework completion for patients who prefer this method.
For example, we are leveraging technology to allow patients to practice and learn CBT skills easily and conveniently by completing digital homework activities in a mobile app, and immediately sharing the results of these activities with the therapist directly in our electronic health record. Our patients and therapists have said that completing homework in this way improves their communication and might even enhance their relationship. We look forward to continuing to learn how our patients use these digital tools and refining them to enhance our interventions, while improving their reach and accessibility.
ABCT provides a meaningful opportunity for us to reflect on how much progress has been made in improving the quality of and access to evidence-based mental health care, but also reminds us that as always there is opportunity to learn and advance in the field of mental health care.
At AbleTo we are dedicated to consistent quality improvement that relies on partnership with our colleagues in research and health care to ensure that we are offering the most cutting-edge evidence-based care. What’s exciting is to be at a place where we have the reach to make evidence-based care more accessible to those most in need and where we have the commitment to continue to find innovative ways to bring evidence-based practice to scale.