Digital cognitive behavioural therapy provides lifeline for busy employees

Accessible, practical offerings also cost-effective for employers: Experts
By Marcel Vander Wier
|Canadian HR Reporter|Last Updated: 02/28/2019
Mental Health
Taking a digital approach to mental health therapy is an effective way for employers to address disability risk and return-to-work issues, say experts. Shutterstock

Alongside musculoskeletal injuries, mental health struggles are causal factors behind many disability leaves.

And while employers have worked hard to improve on early intervention and return-to-work programs, disability prevention amidst changing workplaces remains an issue requiring constant attention, according to Paula Allen, vice-president of research and integrative solutions at Morneau Shepell in Toronto.

“All the risk factors are pointing to an increase over the next few years in these claims,” she said. “The demands on an employee right now (versus) 15 years ago, or even five years ago, are vastly different, and in five years time will be more different as well.”

“The nature of jobs, how people do jobs, it’s very personal. And that’s really what’s having the highest impact.”

Taking a digital approach to mental health therapy is an effective way for employers to address disability risk and return-to-work issues, said Allen, speaking at a recent conference in Richmond Hill, Ont., by Schedule 2 Employers Group.

Cognitive behavioural therapy (CBT) is now available on real-time digital platforms, she said. For example, internet cognitive behavioural therapy (ICBT) provides counsellor-guided treatment that is personalized and suitable for a spectrum of mental health concerns.

“This is not just a bright, shiny new toy,” said Allen. “It is the most researched and one of the most effective interventions for a range of disorders.”

“It retrains your brain to respond to whatever the stressor is… in a way that’s more productive.”

“It’s skill building, it’s learning, it’s practical — which makes it empowering,” she said. “Most people feel good about what they’re acquiring, as opposed to feeling disempowered.”

Alternative to public system

Digital therapy also provides an excellent alternative to psychological services provided by the public health system, according to Sam Duboc, CEO of Beacon, a digital mental health provider in Toronto.

“Really, the public system is geared to those that are critically ill,” he said. “If you’re not critically ill, you have six-, 12-, 18-month wait times in certain cases.”

Digital therapy can fill that treatment gap for people suffering from mild to moderately severe mental health symptoms related to mood, anxiety, depression and post-traumatic stress disorder (PTSD), said Duboc.

“It can effectively treat those people in a way which removes all of the time and geographic barriers of normal treatment.

CBT helps users ward off cycles of depression through teachings provided via readings, videos, thought records and homework, he said.

“It teaches you how to stop that spiral… It teaches you how to pull yourself back up,” said Duboc.

“It teaches you how your thoughts and actions affect your emotions and, therefore, how to retrain your thoughts and re-task your thoughts, as well as your actions, to help better your emotions.”

With the help of a therapist, users are guided through readings and activities in an effort to reclaim control over situations, he said.

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Risk factors

Organizational change often has a negative impact on the well-being of workers, though risk factors causing mental disorders range much more broadly, from chemical
imbalances to drugs and alcohol, concussions and sleep issues, said Allen.

Genetic disorders, nutrition and cannabis use are also factors, as some marijuana users have a “genetic predisposition to responding to cannabis in a way that creates psychosis,” she said.

It is important to distinguish that it’s not actually mental illness that disables workers, but rather its symptoms, she said.

“A diagnosis doesn’t create disability. It’s the symptoms that create impairment — that create disability. The majority of symptoms that we’re seeing are anxiety and depressive symptoms.”

Isolation and high-functioning depression are newer trends that employers should be aware of, she said, as isolation is now the third-highest stress factor among workers, at 42 per cent, behind financial stress (62 per cent) and aging parents (43 per cent), said Allen, citing a Morneau Shepell survey.

Meanwhile, high-functioning depression often occurs among high performers through symptoms such as increased perfectionism, irritability and relentless criticism. And high performers are handling a lot of strain at present, she said.

“The need to have high performers has never been as significant as it is right now.”

CBT retrains the brain to respond to stressors, and builds skills to reinforce positive change to combat unhelpful perceptions, emotions and behaviour patterns, said Allen.

Weekly module treatment typically lasts eight to 10 weeks, she said, and the resulting alterations in brain circuitry provide long-term benefits not available through other mental health treatment options such as medication.

CBT reshapes how a patient’s brain responds to various situations — reversing the effects of prolonged stress — allowing for a reduction of symptoms and increased productivity, according to Allen.

“How you perceive what your emotion is — what your behaviour is — is highly effective intervention for not only mental disorders, but also sleep disorders and pain.”

Takeaways for HR

The most effective ICBT includes a therapist specific to each patient, and trims away typical costs associated with in-person meetings and extended work absences, she said, meaning lower costs for employers looking to combat mental health issues while providing a return to proper health.

“Internet-based cognitive behavioral therapy has a therapist, has a clinical protocol, has efficacy,” said Allen.

In-person CBT is going to go way over a set financial maximum limit, while ICBT is much more cost-effective, she said.

“This is an opportunity for you to reduce claims; it’s an opportunity to offer therapy in a very accessible way to employees,” said Allen.

“It’s… also very helpful in helping people feel productive when returning to work.”

From an employee standpoint, scalable digital options are more manageable and attractive as they are convenient and allow for anonymity, she said.

And the ecosystem in which digital therapy is offered to employees is important — it needs to be appropriately delivered.

Digital therapy options can be offered through an EFAP (employee and family assistance plan) or by way of reference through workers’ compensation professionals and disability managers, said Allen.

“There’s a lot of triggers. One entry point is not my recommendation.”

And because a therapist is involved, digital therapy can be included within paramedical plans for reimbursement, she said.

Digital therapy can also be completed by employees without fear of backlash or stigma, said Duboc.

And employers and human resources professionals should work to reduce as many barriers as possible to allow staff an opportunity for early intervention, he said.

“Encourage people — even when they’re feeling lightly ill — to do it,” said Duboc.

“Eliminate all the barriers. Make it easy to access… Make sure people know about it.”

“Digital provides the option and the promise of helping those that are mild to moderate to moderately severe to get help immediately.”

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