Digital cognitive behaviour therapy (CBT) in Canada: Ethical considerations.
Bibliographic record
Abstract
On the surface, computer- or Internet-based cognitive behaviour therapy (CBT) appears to be a convenient and efficacious method of delivering the well-established protocols of CBT. However, caution is warranted before digitised CBT can be conceptualised as a natural extension of face-to-face CBT. The key difference in digitised CBT is its mode of delivery, but this distinction significantly influences the client's experience of CBT. The treatment settings of digitised CBT interventions are diverse and may include on-site treatment at a clinic computer station, Internet-delivered CBT at a location of the patients' choosing, or delivery of CBT through mobile technologies such as smartphones and tablet computers. To varying degrees, such settings are less controlled and could therefore introduce factors that not only deviate from well-established, manualised, in-person CBT treatments, but also introduce ethical issues for the well-meaning clinical psychologist who prescribes CBT. This article reviews the core features of digitised CBT interventions and examines potential ethical concerns of digitised CBT as they relate to the principles of the Canadian Code of Ethics for Psychologists. Issues related to accessibility, cost, confidentiality, record keeping, risk assessment, and the role of the therapist are explored. Areas in need of further consideration are suggested, and recommendations that align with the Code of Ethics are provided for Canadian clinicians.Keywords: cognitive behaviour therapy, iCBT, digital CBT, e-therapy, code of ethics, electronic record-keeping, access to therapyResumeEn surface, la therapie cognitivo-comportementale (TCC) assistee par ordinateur ou par l'Internet semble etre une methode pratique et efficace de delivrer les protocoles bien etablis de TCC. Il convient toutefois de faire preuve de prudence avant de conceptualiser la TCC numerisee en tant qu'extension naturelle de la TCC en personne. La difference cle dans la TCC numerisee reside dans son mode de transmission. Or, cette distinction influence significativement l'experience du client face a la TCC. Les contextes de traitement des interventions de TCC numerisees sont varies, pouvant comprendre le traitement sur place a un poste d'ordinateur dans une clinique, la TCC assistee par Internet dans un heu determine par le patient, ou la TCC prodiguee par des technologies mobiles telles que les telephones intelligents et les tablettes electroniques. A des degres divers, de tels contextes sont moins controles et donc susceptibles d'introduire des facteurs qui peuvent non seulement devier des TCC en personne, manuelles et bien etablies mais aussi introduire des problemes ethiques pour le psychologue clinique bien intentionne qui a prescrit la TCC. Cet article examine les caracteristiques principales des interventions par TCC numerisee et evalue les preoccupations potentielles d'ordre ethique de la TCC numerisee par rapport aux principes du Code canadien d'ethique pour les psychologues. Les questions liees a l'accessibilite, aux couts, a la confidentialite, a la tenue des registres, a l'evaluation des risques ainsi qu'au role du therapeute y sont explorees. Les domaines necessitant une consideration plus approfondie sont suggeres et les recommandations en lien avec le Code d'ethique sont fournies aux cliniciens canadiens.Mots-cles : therapie cognitivo-comportementale, TCC individuelle, TCC numerisee, therapie electronique, code d'ethique, tenue de registres electronique, acces a la therapie.With the continued increase of smartphones, tablets, and general Internet use over the last decade, psychology as a discipline has begun to embrace the advantages of computerised communication technologies to offer clients therapeutic interventions within this digital milieu. However, due to the rapidly changing nature of technology, it is difficult for formal ethical guidelines to keep pace with the realities of advancing research and clinical methodologies. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.043 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.016 | 0.007 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".