‘Computerised Cognitive Behavioural Therapy’ (CCBT) by combining Cognitive Behaviour Therapy (CBT) and online learning. CCBT is defined as a “generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system” (National Institute of Health and Care Excellence, NICE, 2012). In line with this, IC Ltd have developed a number of online systems, ‘Hubs’, which focus on addressing offending behaviour, capturing the full range of offending pathways.
Effectiveness of CCBT: Research directly comparing CCBT with face-to-face CBT indicates that CCBT can be as effective as conventional CBT, with no statistically significant difference between the two (Andersson, & Cuijpers, 2009; Cuijpers et al. 2010). Furthermore, CCBT has been found in meta-analyses to be cost-effective in comparison to conventional interventions, including group treatments (Musiata, & Tarriera, 2014). As such, NICE have endorsed this approach as an effective treatment option (NICE, 2009).
Theoretical framework of the Hubs: The content of the Hubs are based on the cognitive behavioural model. The model comprises both cognitive and behavioural elements; the cognitive component recognises the impact of thoughts and beliefs on feelings and subsequent behaviours, such as offending behaviours. The behavioural element focuses on how offending and negative behaviours are learned through conditioning and reinforcement. As an approach, the cognitive behavioural model seeks to understand both why a person choses particular behaviours and then identifies ways of replacing these with more positive and pro-social skills and behaviours with the advantage of empowering service user’s to take personal responsibility (Chui, 2003:68-9; Winstone, 2006:79-81). Although CBT underpins all of the Hubs, they are also informed by other relevant theoretical perspectives, such as the Transtheoretical Change model (Prochaska, & DiClemente, 1983) and the Duluth (1981) model of domestic violence.
Format of the Hubs: The Hubs developed by IC Ltd take the service user through three sections; Knowledge, Understanding and New tools:
Knowledge: The service user is presented with multi-modal information to help develop an awareness of the subject matter.
Understanding: Reinforces understanding by enabling the service user to apply the knowledge to themselves whilst also helping practitioners identify any areas of concern or development.
New Tools: The service user is offered a number of problem solving strategies and skills to make sustainable changes.
Considerations for CCBT: Different factors can influence the effectiveness of online learning, such as an individual’s learning style, their computer literacy and the environment in which it is undertaken in (Santally, & Senteni, 2013). IC Ltd has considered these factors when designing its online Hubs in the following ways:
Responsivity: The inclusion of audio bars, written text, videos, images and active participation attempts to ensure that the Hubs are accessible to all learning styles
Design: The clear graphics, tabs to change pages and exercise instructions enables even those with the most basic of computer knowledge to access the programme.
Target audience: IC Ltd recognises the importance of high intensity interventions such as accredited programmes. Therefore, it does not seek to replace these but supports the appropriate targeting of interventions through increasing service user accessibility. Furthermore, IC Ltd is aware of research indicating that high intensity interventions may actually be harmful to low risk service users and paradoxically increase reoffending rates (Raynor, 2002). With this in mind, the Hubs are designed for service users of low and medium risk of harm with the overarching aim of lowering risk.
Design integrity: One of the central principles of effective practice is that of integrity; taken in this instance to mean ‘delivered as intended’ and ‘in consensus with the theoretical models informing it’ (Vanstone, 2004). The structure of the Hubs prevents the work from being adapted to the point that the effectiveness is lost. Where elements of programmes or prescribed work become overly ‘adapted’ or indeed left out altogether, or where professionals are not appropriately trained (Hollin, 1995 cited in Winstone, 2006) the effectiveness is reduced. Not only does this undermine the value of the work but a lack of integrity also creates problematical issues in further research and evaluation.
Service user engagement: Cuijpers et al. (2010) found no statistically significantly difference between attrition rates between those undertaking face-to-face CBT compared to CCBT. Furthermore, it could be argued that the 24 hour availability of the Hubs make these interventions more accessible, particularly for those who may be reluctant to engage in face-to-face interventions.
Integrating CCBT into service design: The Hubs are designed so that they can be used as part of the service user’s Order (for example the Rehabilitation Activity Requirement and Supervision Requirement) and as such, the service user will not be completely isolated but should have opportunities throughout the length of the programme and their Order to discuss any issues raised. In line with this, research indicates that the efficacy of CCBT is increased when it is supported by professional guidance, even when this contact is considered to be limited (Cuijpers et al. 2010).
Article Created by the IC LTD Team
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