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iCBT (internet-based Cognitive Based Therapy) and EFAPs

We recently had a suggestion to write a Johnstone’s Journal on the topic of ‘wellness’. A common view is that wellness encompasses seven dimensions: mental, physical, social, financial, spiritual, environmental, and vocational. These dimensions are interdependent and influence each other, and when one dimension of a person’s well-being is out of balance, the other dimensions are affected.

In the next Johnstone’s Journal, we’ll review Wellness Spending Accounts and Health Spending Accounts, two current ‘wellness’ benefits that employers are using to attract and retain their employees. In this month’s Journal, our focus is on ‘mental wellness’.

Mental wellness includes all aspects of mental health, emotional state and well-being, such as anxiety, mood, depression, stress management, self-care, suicide prevention, as well as how they interact. Mental wellness influences how we think, feel, and behave in our daily lives.

LifeWorks Mental Health Index 2021 concluded “we’re in a mental health crisis’ and identified rapid, seismic shifts are significantly impacting our lives at work and home – the pandemic, the move to a digital workforce, and the “great resignation”. They have some alarming statistics:

• 1 in 3 people are at high risk of a mental health issue (depression, anxiety, addiction)
• 4 in 5 managers are supporting a least one employee with a mental health issue
• More than 50% of employees are experiencing burnout

Mental wellness is a growing area of focus for group insurance plans, often addressed as part of the Employee and Family Assistance Plans (EFAPs). LifeWorks says it well: a comprehensive EFAP maintains the wellbeing, health and therefore, job performance of each employee.

There are a number of strategies that employees are encouraged to use to enhance their mental wellness, including:

• Practice mindfulness: the mental state achieved by focusing your awareness on the present moment, instead of mentally rehashing the past or imagining the future.
• Use relaxation and self-care strategies that work for you.
• Seek support from family, friends, community, and/or a professional.
• Exercise regularly, eat well, and get enough sleep.
• Express feelings and emotions effectively, and practice positive self-talk.

Internet-based Cognitive Behavioural Therapy (iCBT)

Both LifeWorks and Homewood Health offer iCBT tools and programs to their clients as part of their EFAPs. LifeWorks program is called ‘AbilitiCBT’ and Homewood Health offers ‘Sentio’ which is currently replacing their previous version ‘iVolve’. iCBTs do not take the place of assistance offered in a crisis situation.

The benefits of iCBTs are many, not the least being that iCBTs are less expensive than in-person talk therapy (one-third of the cost), and iCBTs make it easier for employees to access and schedule than in-person talk therapy.

What is Cognitive Behavioural Therapy?

Cognitive behavioural therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

CBT is based on several core principles, including:

• Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
• Psychological problems are based, in part, on learned patterns of unhelpful behaviour.
• People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.

CBT treatment usually involves efforts to change thinking patterns. These strategies might include:

• Learning to recognize one’s distortions in thinking that are creating problems, and then to re-evaluate them in light of reality.
• Gaining a better understanding of the behavior and motivation of others.
• Using problem-solving skills to cope with difficult situations.
• Learning to develop a greater sense of confidence in one’s own abilities.

CBT treatment also usually involves efforts to change behavioural patterns. These strategies might include:

• Facing one’s fears instead of avoiding them.
• Using role playing to prepare for potentially problematic interactions with others.
• Learning to calm one’s mind and relax one’s body.

Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy.

CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behaviour.

CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.