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Monday, April 28, 2008

Computer Based Psychotherapy

Patients often improve more with computer based cognitive-behavioral psychotherapy than with conditions such as waiting list control or care as usual, says a recent review. This is coupled with an over 50% cut in usual therapist time. This review is published in a book: Hands-on Help Computer-aided Psychotherapy. A book review in the Am. J. Psychiatry

Hands-on Help is a narrative review of the mushrooming field of computer-aided psychotherapy for mental health problems as a whole, from the time it began in the 1960's through to the present day. The many types of computer-aided psychotherapy and how each might be accessed are detailed together with the pros and cons of such help and the functions it can serve. The authors review prevention as well as treatment.

Such a therapy for depression in the UK is called: Beating the Blues
Beating the Blues® is a computerised cognitive behavioural therapy (CCBT) program for depression and anxiety that is available via CD-ROM and the Internet. It has been shown to be a cost effective and time efficient way of helping people suffering from these conditions to get better and stay better. In Feb 2006 the National Institute of Health and Clinical Excellence (NICE) recommended Beating the Blues® as a treatment option for all people seen with mild or moderate depression.

Cognitive-behavioral psychotherapy is a form of psychotherapy that lends it self well for a computer based program. Computer based forms of Psychoanalytic Psychotherapy are far more complicated to my opinion. We recently discussed using a blog during psychodynamic psychotherapy, blogtherapy. Based on this review you can conclude that at least some patients may benefit from this kind of therapy. Nevertheless despite a lot of research questions about computer based psychotherapy remain.

  • As with other new developments healthcare companies are reluctant to pay for this kind of therapy. What should be the price and who do you have to pay. The developer of the program, the therapist working with patient and computer?

  • How much human contact with the therapist is best? No human contact at all in these programs are associated with large drop out rates.When should human contact be necessary, with intake or followup or during the program for monitoring progress?

  • How should human contact take place, by telephone, email, face to face?

  • What should be the background of the therapists? Psychologists trained in cognitive behavioral therapy, trained nurses, general practitioners, trained volunteers?

  • Most trials with CBT were with care as usual and waiting lists conditions. These trials suffer from a large placebo effect and high expectancy of the participants of the new treatment. Trials with comparison to other therapies are necessary. Knowledge of what works in this kind of psychotherapy is still fragmentary.

  • Some patients prefer live to computer-guided help. Not all depressions can be treated by computer psychotherapy. Mostly mild to moderate depression can benefit, more severe forms of depression will still need other forms of therapy of which medication is one.

Overall computer aided psychotherapy as an early option in the treatment of depression is opening up new possibilities. It can be a cost-effective treatment that can reduce chronicity and perhaps even prevalence of depression. Will computer-aided psychotherapy integrate smoothly into the palette of therapeutic options? A lot of research and time will tell.

Computer based cognitive-behavioral therapy is not only used in depression but also in other psychiatric conditions such as anxiety disorders, obsessive-compulsive disorders and problem drinking to name a few.

Advantages are:

  • No lengthy clinician contacts

  • Reduce waiting lists

  • No travel to a therapist

  • No stigma

  • Self-empowerment

What is Computer aided cognitive-behavioral therapy?
Computer-aided cognitive–behavioural therapy (CCBT) is any computing system that aids cognitive–behavioural therapy by using patient input to make at least some computations and treatment decisions. This definition excludes video conferencing and ordinary telephone and electronic mail consultations, chat rooms and support groups, which expedite communication and overcome the tyranny of distance but do not delegate any treatment tasks to a computer or other electronic device. It excludes, too, the electronic delivery of educational materials and electronic recording of clinical state or behaviour where those allow no more interaction than do paper leaflets and workbooks.

Computer-aided therapy may be delivered on a range of computing devices, such as stand-alone personal computers, internet-linked computers, palmtops and personal digital assistants, telephone interactive voice response systems, gaming machines, CD–ROMs, DVDs, cellphones and virtual reality devices.

This post was inspired by a recent editorial in the British Journal of Psychiatry.
Marks, I.M., Cavanagh, K., Gega, L. (2007). Computer-aided psychotherapy: revolution or bubble?. The British Journal of Psychiatry, 191(6), 471-473. DOI: 10.1192/bjp.bp.107.041152

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