inconvenience. To the extent clients are able to
access mental health services from any location
that has telephone or Internet service, this would
mitigate the problem or concern. In addition, with
the advent of computer-assisted treatment, the
available “hours of operation” are likely to be
extended, especially in cases in which immediate
response from a clinician is not needed. Finally,
there are many efficiencies afforded by computer-
assisted treatment. For example, electronic records
of all interactions between client and clinician
are stored, the viewing of Web pages and comple-
tion of homework assignments can be time-
stamped, and these interactions can more easily be
incorporated into electronic health records. In
2004, President Bush called on the United States
health care industry to develop electronic health
records and make them available to all patients by
the year 2014.
There are now over 100 studies that have
examined the effects of computer-assisted therapy
for a variety of psychological problems, including
mood disorders, eating disorders, anxiety disorders,
and substance use disorders (Marks, Cavanagh, &
Gega, 2007). Two recent examples of studies com-
paring computer-assisted and standard treatment of
psychological conditions may be instructive.
One of the most effective treatments of depres-
sion is cognitive therapy. Wright et al. (2005)
developed a computer-assisted form of cognitive
therapy and compared its ability to decrease depres-
sive symptoms to that of a standard form of this
treatment, therapist-led cognitive therapy. Results
indicated that both the computer-assisted and tradi-
tional cognitive therapy produced significant reduc-
tions in depressive symptoms over the 8 weeks of
treatment, and both treatments showed roughly
equivalent effects, which were maintained at 3- and
6-month follow-up assessments. These results show
promise for a computer-assisted cognitive treatment
for depression, especially given that the clients rated
the treatment positively in terms of acceptability,
relatively low dropout rates occurred, and both
time- and cost-savings related to therapists were
afforded by this treatment.
Bickel, Marsch, Buchhalter, and Badger (2008)
evaluated the efficacy of an interactive, computer-
assisted behavior therapy intervention with opioid-
dependent outpatients. The effects of a computer-
ized version of the community reinforcement
approach were compared to those delivered by a
therapist. This treatment includes training in a vari-
ety of life skills (e.g., self-management, drug refusal,
time management, relapse prevention, etc.) with
voucher-based contingency management. The lat-
ter involves clients being able to earn voucher
points that could be traded in for money at the
end of treatment; more voucher points were
awarded for longer stretches of sobriety, whereas a
relapse resulted in losing all voucher points awarded
to that point. At the end of treatment, the average
number of continued weeks of sobriety and treat-
ment retention was similar across treatment groups.
Despite one-sixth as much contact with a therapist,
this much less expensive computer-assisted treat-
ment produced similar results in terms of abstinence
and sobriety!Culturally Sensitive Mental Health Services
The U.S. Census Bureau projects that the popula-
tion growth rate for non-Hispanic Whites between
the years 1995 and 2050 (7.4%) will be the
lowest of all major ethnic/racial groups in the
United States. In contrast, it is projected that
the Black population will increase 69.5%, the
Native American population 83.0%, the Hispanic
population 258.3%, and the Asian American popu-
lation 269.1%.
Data from the 2010 U.S. Census reinforces this
changing ethnic landscape. In 2010, 16% of the
total U.S. population self-identified as Hispanic or
Latino, 13% as Black or African American, 5%
as Asian American, 1% as American Indian or
Native American, 2% as two or more races, 0.2%
as Native Hawaiian of other Pacific Islander, and
72% as White. Of greater interest is that fromCURRENT ISSUES IN CLINICAL PSYCHOLOGY 83