Online therapy a growing option in Minnesota health care

A Minnesota health insurer has added digital cognitive behavioral therapy (CBT) as a benefit, reflecting the rapid growth of online mental health care and of one local provider.

PreferredOne added Minneapolis-based Learn to Live's online CBT this past week as a benefit for self-insured workplace health plans. The goal is to help people with depression and anxiety who would otherwise struggle with the costs and time commitment of traditional CBT.

"Many teens and adults experience emotional health challenges but lack access to help," said Dr. Abbie Miller, chief medical officer of Golden Valley-based PreferredOne.

Traditional CBT often involves talking to therapists and engaging in "exposure" sessions to confront sources of stress or anxiety. Learn to Live replaces the talk sessions with self-directed training, journaling and therapeutic games — while giving patients access to local therapists via phone, text or videoconferencing.

The company hasn't published results yet in a peer-reviewed medical journal, but internal data show a 30% reduction, on average, in symptoms for patients with depression who complete the online CBT, said Dale Cook, Learn to Live's co-founder and chief executive.

"Even in face-to-face therapy, that's a very good outcome," he said.

Online CBT has been proposed as a solution for years to shortages of therapists or to other barriers, such as travel, that make it hard for patients to keep appointments. Initial studies have shown promise in addressing insomnia and other disorders. Mayo Clinic debuted its Anxiety Coach mobile app in 2012.

A recent study of a therapeutic app called PTSD Coach found that only 37% of 150,000 people actually used it after downloading it.

Cook said Learn to Live tries to keep users engaged by having therapists check in with them and by offering support from peers who are also using the app. While some users might only complete 45-minute training sessions in four-minute bursts — between checks of Twitter — Cook said that is OK.

"What we seek to do is become a part of that habitual check-in, because that over time really adds up," he said.

Support also can help when people struggle with CBT activities, he said. A patient with social anxiety might need a nudge, for example, to complete an exposure therapy task of going into a coffee shop.

The online approach for now appears to work with mild to moderate levels of depression and anxiety, Cook said. Severe disorders probably merit traditional therapy.