CBT4CBT is a computer-based version of cognitive behavioral therapy (CBT) used in conjunction with standard clinical care for current substance users.
Six modules and follow up assignments focus on key concepts in substance use, including cravings, problem solving and decision making skills. The multimedia presentation, based on elementary level computer learning games, requires no previous experience with computers.
Link to commercial site here.
Cognitive-Behavioral Therapy (CBT)
Reduction of drug use
Retention in treatment
Young Adults (18-30)
Community-based outpatient treatment center
Computer-assisted delivery of cognitive-behavioral therapy for addiction: A randomized trial of CBT4CBT.
Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Nuro KF, Gordon MA, Portnoy GA, Rounsaville BJ. American Journal of Psychiatry. 2008. 165(7):881-888. PMCID: PMC2562873.
Summary: Self-report of illegal drug use was verified by urine toxicology screens at each twice-weekly assessment. 66% retention. Participants assigned to CBT4CBT submitted significantly fewer urine samples positive for any drug, especially cocaine and had longer periods of continuous abstinence during treatment. Completion of practice assignments was significantly correlated with outcomes. The number of days abstinent was not significantly different between groups, nor was the retention rate between conditions.
Take Away: CBT4CBT plus clinical practice is more effective in reducing drug use during treatment than standard outpatient therapy alone.
Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A six-month follow-up of CBT4CBT.
Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Rounsaville BJ. Drug and Alcohol Dependence. 2009. 100(1-2):178-181. PMID: 19041197.
Summary: Random effects regression analysis found that of 60 participants followed at least once, those randomized to adjunct CBT4CBT treatment submitted more drug-free urine samples at 1,3, and 6 months after treatment, than those randomized to treatment as usual who tended to increase drug use in the follow up period. Self-report of illegal drug use verified by urine toxicology screens at 1, 3, and 6 month evaluations.
Take Away: The positive treatment effects of CBT4CBT plus clinical practice remained significantly more effective at 6 month follow up than clinical practice alone.
Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction.
Olmstead TA, Ostrow CD, Carroll KM. Drug and Alcohol Dependence. 2010. 110(3):200-207. PMCID: PMC3033701.
Summary: Incremental cost-effectiveness analyses found that adding CBT4CBT to standard care resulted in an additional per-patient cost of $39 in clinic costs, and $27 in patient costs.
Take Away: Although no consensus threshold value exists for outcomes in addiction services, CBT4CBT effectively reduced the number of drug-free urine specimens for a moderate cost per patient.
Cognitive function and treatment response in a randomized clinical trial of computer-based training in cognitive-behavioral therapy.
Carroll KM, Kiluk BD, Nich C, Babuscio TA, Brewer JA, Potenza MN, Ball SA, Martino S, Rounsaville BJ, Lejuez CW. Substance Use & Misuse. 2011. 46(1):23-34. PMCID: PMC3083447.
Summary: Pre- and post-treatment administration of the Shipley Institute of Living Scale, Continuous Performance Test II, WAIS-III Digit Symbol-Coding, and the BART (Balloon Analogue Risk Task) were used to determine the effects of four domains of cognitive functioning on drug use outcomes and treatment retention. Of the 60 participants who completed a post-treatment interview, 40% were considered impaired by one or more test. Of the 4 domains tested, risk taking was significantly associated with drug use outcome, retention, but only for those assigned to the CBT4CBT condition.
Take Away: Substance abusers who are more prone to risky behavior may benefit less from CBT4CBT.
Computer-assisted delivery of cognitive-behavioral therapy: Efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone.
Carroll KM, Kiluk BD, Nich C, Gordon MA, Portnoy GA, Marino MA, Ball SA. American Journal of Psychiatry. 2014. 171(4): 436-444. PMCID: PMC4042674.
Summary: In this replication study, participants (n=101) were randomly assigned to standard methadone maintenance and weekly group sessions (TAU) or TAU plus CBT4CBT over a period of 8 weeks. All participants had comparable exposure to counseling. For the intent-to-treat analyses, there were no significant differences between groups on attainment of 3 or more continuous weeks of abstinence, or submission of drug-free or cocaine-free urine specimens. Analyses of treatment completers revealed significant reductions in positive urine specimens (drug or cocaine), however no differences were detected for self-reported percent of days abstinent.
Longitudinal outcomes showed significant reductions in cocaine use over time for both groups, with a significant treatment effect indicating greater reductions in cocaine use for the CBT4CBT group. Six-month follow-up data show the durability of benefits of CBT4CBT over time compared with TAU.
Take Away: CBT4CBT plus methadone maintenance therapy is more effective in reducing drug use during treatment (consistent with the previous RCT) than standard methadone maintenance therapy alone, especially among a challenging, cocaine-dependent population enrolled in methadone maintenance programs.
Follow-Up of Previous Study
Only connect: The working alliance in computer-based cognitive behavioral therapy.
Kiluk BC, Serafini K, Frankforter T, Nich C, Carroll KM. Behaviour Research and Therapy. 2014. 63c: 139-146. PMID: 25461789.
Summary: As part of a randomized controlled trial of CBT4CBT, the authors examined the impact of the working alliance on substance use outcomes of patients in methadone maintenance treatment (MMT) (Carroll et al, 2014). Cocaine dependent patients (n=101) were randomly assigned to usual methadone maintenance treatment (TAU), or to TAU plus the CBT4CBT program. The authors developed the Working Alliance Inventory for Technology-Based Interventions (WAI-Tech) to measure the working alliance between participants and CBT4CBT. This measure was derived from the Working Alliance Inventory (WAI), which assesses the therapeutic alliance between patients and therapists. While participants in TAU were given the WAI and asked to rate the alliance with their therapist in the MMT program, participants getting CBT4CBT plus TAU were given the WAI-Tech at 2-, 4-, and 8-week follow-ups.
The WAI-Tech was found to have excellent internal validity overall (Cronbach Alpha=0.92). When compared to the WAI, the WAI-Tech had similar mean scores and stability throughout the study period. Participants getting CBT4CBT reported having a favorable working alliance with the program. For TAU participants, higher WAI total score was associated with fewer days of cocaine use after treatment. This relationship was not found for participants in the CBT4CBT group. The WAI-Tech total score was not associated with any substance use outcomes.
Take Away: The WAI-Tech is a psychometrically sound measure to assess working alliance with a technology program. Despite this, working alliance and treatment outcomes may have a different relationship in the context of a computer-based treatment.