Our research group at Yale has taken a programmatic approach to development of computerized CBT based on the Stage Model of Treatment Development (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2013; Rounsaville et al., 2001). The Stage Model emphasizes a systematic, programmatic approach to treatment development and refinement so that the most potent version of an intervention is developed in a form compatible with clinical practice. In 2004, after recognizing that CBT was not being widely implemented with high levels of fidelity in clinical practice at Stage 3, we returned to Stage 1 with the goal of developing a maximally efficient, computer-delivered version of CBT that retained key features associated with clinician-delivered CBT, including durability of effects (Carroll et al., 1994a). Thus, we sought to develop a highly engaging, interactive approach that emphasized (1) conveying key cognitive and behavioral interventions as effectively as possible, and (2) practice of targeted skills via practice in the real world. As noted above, a significant limitation of many studies of online interventions is low levels of uptake and retention; thus, we sought to make the
