The Two Chairs Clinical Innovation and Research Team is tasked with designing and developing mental health interventions and products that support our therapists and lead to meaningful improvement for our clients.
In November, we attended the 2024 Association of Behavioral and Cognitive Therapies (ABCT) annual meeting to discuss the latest science and trends in cognitive behavioral therapy (CBT) and discuss pressing challenges in the field.
We are excited to share our key takeaways from the meeting and thoughts on how Two Chairs and the technology-enabled behavioral health field more broadly can use innovation to address the current challenges in mental health care.
- Artificial Intelligence (AI) can support therapists, but probably won’t replace them anytime soon
Perhaps not surprisingly, there was a lot of talk about how AI can be used to improve outcomes in mental healthcare. We’ve seen a lot of industry buzz about how AI chatbots and other tools might provide services directly to clients, or even replace human therapists. At ABCT, it was clear that these tools aren’t ready to do that, but they do have real potential to support therapists and improve overall quality of care.
For example, training and supervision are key levers to improving therapist performance and ensuring clients receive appropriate and adequate care. However, supervisors often have a significant blind spot: getting into the therapy room to understand what therapists are actually doing is either not feasible, or involves long hours of watching live or recorded sessions.
In contrast, AI can tirelessly listen, transcribe, and drive insights into therapist and client behavior — getting trainees immediate feedback and helping supervisors focus on the most important parts of a session. Clinical supervisors noted that AI summaries of sessions will often highlight areas that trainees didn’t remember or didn’t think were important, which helps supervisors hone in on areas for clinical skills development more efficiently.
Another advantage of AI is that it’s always available! Therapists, being human, are not able to respond to their clients’ needs at all times between sessions. Several researchers talked about the development of AI tools that can provide evidence-based support and answer questions outside of the session at the moment where clients need the help. This can help enhance client learning and drive faster improvement.
We found these applications of AI to be very exciting and anticipate that broader adoption of these tools will help enhance therapists’ competence and performance, improve efficiencies in the mental health care system, and ensure that clients are receiving high quality and effective care. We look forward to exploring applications of AI within our services at Two Chairs.
- Successful implementation of measurement-based care (MBC) requires listening to the voices of stakeholders
In recent years, there has been a growing push to integrate MBC into mental health care systems. However, the process of adopting MBC, especially within community treatment settings, requires thoughtful planning and collaboration. A panel discussion at ABCT focused on how co-creating MBC with health systems can address some of the key challenges to adoption and sustained use of these systems.
One of the main barriers to adopting MBC is the sheer volume of competing demands and administrative tasks. Providers are often overwhelmed by paperwork, making it difficult to prioritize MBC. Clinicians may struggle to interpret MBC scores and may not see how the data directly informs treatment decisions. Effective adoption and sustained use of MBC requires tailoring of these processes to specific systems and populations and seamless integration into existing workflows—without adding more paperwork or administrative burden.
A key to overcoming these challenges is to engage all stakeholders—from clinicians and administrators to clients—in the design of MBC systems. Co-designing these systems ensures that the tools are relevant to the people using them. Similarly, clinicians may need better training on how to interpret and use data in real-time.To make MBC work for different treatment settings, it’s crucial to integrate community voices into the process.
At Two Chairs, MBC is a key part of our care model. We’ve made investments to ensure that our MBC technology and processes are designed alongside our end users – clinicians and clients. We have also put significant resources into ensuring that everyone at Two Chairs, from leadership to clients, understands and is committed to using data-driven decision support in care.
- Mental health professionals have a responsibility to ensure that investments in innovation are actually moving the needle on the mental health crisis
There has been a slow-motion reckoning in academic circles over the past three decades over the fact that the outputs of science and research often have minimal impact on the peoples we are trying to help.
The problems here are well-known: there are many barriers to overcome for an effective mental health intervention to make it from a research setting into clinical practice, including inadequate dissemination and implementation efforts and misaligned incentives for the “on the ground” providers to learn and provide new treatments.
At ABCT, several influential treatment researchers discussed how incentives within academia favor “innovations” in treatment design and development over addressing the science-practice gap. Although this work has value, it often doesn’t lead to immediate real-world impact. More impactful work may include effort to close gaps in access to high quality care or better understand how to efficiently and effectively develop our mental health workforce.
One key advantage of industry settings is the alignment of incentives. Our team at Two Chairs is focused on the implementation of research findings quickly and efficiently into our clinical population. For example, we use principles of implementation science to improve our clinicians’ adoption and practice of measurement based care. If these practices are successful, it leads to a virtuous cycle: clients have better treatment outcomes, which helps us compete better in the market, which helps us meet our overall goals of providing greater access to high quality mental health treatment.
We are certainly indebted to the researchers who have developed these insights, however, we encourage creative collaborations between academic and industry professionals that have the potential to accelerate the impact that research can have on client outcomes.
- One size does not fit all, but we can work from common ground
Anyone who is familiar with mental health interventions knows there are dozens of catchy acronyms for our evidence-based interventions (EMDR, CBT, ACT, PCIT, PE, CPT, BA, and the list goes on). It can get easy to get lost in the “alphabet soup,” and can be overwhelming for clinicians to feel like they need to be familiar with or know every one of these interventions inside out.
Talks at ABCT provided a helpful reminder that regardless of what type of evidence-based practice or intervention clinicians adopt, there are key principles of behavior change that underlie most of these interventions. This doesn’t mean that the way these interventions are packaged and combined to treat different mental health concerns doesn’t matter, but it does mean that we can zoom out and find more commonalities than differences that can help clinicians– particularly those earlier in their training and career— make sense of this complicated landscape.
One framework for conceptualizing client care and informing treatment plans pulls on the key elements of a broad range of evidence-based practices, including cognitions, behavior, physical sensations, and emotions. These different factors plus an individual's background, values, and experiences shape much of the core of our different interventions.
In addition to these more specific treatment targets, we were also reminded of the importance that the relationship between the therapist and client plays in all treatment modalities.
At Two Chairs, we see value in diversity of perspectives and treatment approaches. We recognize that the one size fits all approach to mental health care doesn’t serve all clients well. We spend a lot of time thinking about cross-cutting principles or elements of care, like the alliance, that drive better client outcomes. Our tooling and systems help reinforce these principles for our clinicians to help ensure that regardless of which evidence-based practice our clients are receiving, that the core elements of effective care are there.
ABCT provides a welcomed opportunity for us to reflect how much progress has been made in improving the quality and access to effective mental health care, but also serves as a reminder of continued challenges and gaps in the field. Two Chairs is dedicated to continuing to innovate to meet some of the biggest challenges that face our clinicians and clients in delivering and accessing high quality care.
