I recently wrote an essay as part of assessment for a course I'm doing about online-enabled Cognitive Behavioral Therapy (CBT) interventions for depression. As part of the assignment brief I looked at four Randomized Controlled Trials of smartphone-enable applications.
The research was interesting and demonstrated some efficiency for blended behavioral intervention interventions where the therapist had less involvement time-wise. There was also some evidence for the effectiveness of interventions delivered completely online with minimal therapist input beyond assessment.
While the findings were promising, unfortunately while I was reading I was stuck by the apprehensive lack of attention paid to ensuring participants were protected from the risks associated with participation.
There was a lot of variance in the level of qualifications and training in CBT required to deliver the interventions. Some masters students also appeared to be too heavily involved in making diagnoses, and there was scant mention of supervision in two papers.
At a very basic level you could argue study participants were not protected to the same extent that you would expect in face-to-face work with clients. In these conditions clinicians would ordinarily be trained to a consistent level and to be engaged in regular supervision.
As someone who has been involved with conducting research online it is relating to think that these aspects of study design might have been overlooked. I'd hope that this was not the case and that ethical details were omitted for brevity following a thorough ethical review where any issues were ironed out.
Irrespective I was left wondering whether in reality it is always the case that academies have enough knowledge about the ethics of real-world practice to weave ethical considerations into the design of randomized controlled trials on online interventions of CBT?
In addition, do therapists have enough representation in ethics committee panels to help impede some of this real-world understanding? Do they also have close enough involvement in the design and implementation of these types of studies?
These are important issues that really need closer attention. Research participants need to be protected in the same way they would be in treatment as usual.
The optimal solution would be to consult with or involve therapists in the research lifecycle, starting out at the outside in the design of studies, then into the ethical approval process and the actual execution of the study itself. This might go some way to promote the laying of good ethical foundations in an emerging field.