For Depression, Computer-Assisted Therapy Offers Little Benefit, Study Finds

It’s unlikely that your therapist will be replaced by a computer program anytime soon.

That’s the takeaway of recent study out of Britain looking at the effectiveness of computer-assisted therapy for depression.

The bottom line: The computer programs offered little or no benefit compared to more typical primary care for adults with depression. That’s largely because the patients were generally “unwilling to engage” with the programs, and adherence faltered, researchers conclude, adding that the study “highlighted the difficulty in repeatedly logging on to computer systems when [patients] are clinically depressed.”

In an accompanying editorial, Christopher Dowrick, a professor of primary care medicine at the University of Liverpool, stated what may seem obvious: Many depressed patients, he wrote, don’t want to interact with computers; rather, “they prefer to interact with human beings.” He noted that the poor result “suggests that guided self help is not the panacea that busy [primary care doctors] and cost conscious clinical commissioning groups would wish for.”

(Lloyd Morgan/Flickr)

(Lloyd Morgan/Flickr)

As part of the study, published in the BMJ, 691 patients suffering from depression were randomly assigned to receive the usual primary care, including access to mental health care, or the usual care plus one of two computer-assisted options that offer cognitive behavior therapy (CBT), a form of therapy that encourages patients to reframe negative thoughts. Patients were assessed at four, 12 and 24 months; those using the computer programs (one called “Beating the Blues” and the other “MoodGYM“) were also contacted weekly by phone and offered encouragement and technical support.

The context of all this is that demand for mental health services generally exceeds supply around the globe, and health systems are seeking ways to bridge the gap. According to the new paper, demand for cognitive behavioral therapy, for instance, “cannot be met by existing therapist resources.” So, the thinking goes, maybe a computer can ease some of the caseload. And in some cases, it works. Indeed, Britain’s National Institute of Health and Care Excellence (NICE) guidelines recommend computerized CBT as an “initial lower intensity treatment for depression….” based on studies that showed it can be effective.

However, results of this latest study may nudge clinicians and policymakers to rethink the computer’s role in therapy.

Here are the results, summed up in BMJ news release:

Results showed that cCBT offered little or no benefit over usual GP care. By four months, 44% of patients in the usual care group, 50% of patients in the Beating the Blues group, and 49% in the MoodGYM group remained depressed…. Continue reading

Tumblr Blocks Some Mental Health Topics, Thwarts Therapy

LibbiAs a member of the Millennial Generation, Libbi Gildea, 20, discovered a new coping mechanism for dealing with an age-old mental health issue – social media.

But just as she started to heal from a personal trauma, she found that a tech giant was starting to dismantle her new, safe space.

In December 2012, Libbi was raped on the campus of a prestigious school in Massachusetts. She was 19 at the time, a college sophomore. After the attack, she developed PTSD and depression and took time off school, trying to heal. She spent time recovering in the hospital, and traditional talk therapy helped. But, she says, she found the most comfort in a more contemporary setting. Libbi joined the microblogging site Tumblr and started browsing posts tagged with topics she was interested in, like depression and PTSD, meeting others that were going through similar experiences. In an interview, she gave me permission to use her name, and explained how she evolved from feeling totally alone after the assault, to much more connected and supported through social media:

I felt really isolated because I didn’t know anyone else that had PTSD. You don’t realize that what you’re experiencing is normal … After I was done with the hospital and I didn’t have group therapy anymore, a friend mentioned that there was a pretty vibrant mental health community on Tumblr.

So I made a blog there. I started randomly one day, posting that I wished I could make a mental health “resume” so I wouldn’t have to go through my experience every time I saw a new doctor. I did another post of more of a personal nature on the night of my birthday because I was angry and feeling that my attacker had taken a lot away from me. I wrote him an open letter that said, “You may have raped me, you may have taken this from me, but I’m still here, and my life is only going to get better, and frankly, I feel sorry for you.” Continue reading

Imagining The Future Of Psychotherapy

The following is a guest post from Jonathan Adler, Ph.D. He is a clinical psychologist and assistant professor of psychology at Franklin W. Olin College of Engineering.

The talking cure has come a long way since Sigmund Freud had women lying on his couch and free-associating several times a week. Today, there are a wide variety of scientifically-supported interventions for a wide variety of problems. But a heated discussion among major players in the psychotherapy world suggests that the standard treatments of today aren’t likely to be the standard treatments of tomorrow.

Jonathan M Adler

Jonathan Adler, Ph.D.

I’m a clinical psychologist myself, with one foot in the world of clinical practice and one foot in the world of academic research. So I’ve been paying close attention to this discussion which was kicked off by an article published last year in the journal Perspectives on Psychological Science. The authors, former president of the American Psychological Association, Alan Kazdin, and his graduate student, Stacey Blase, argued that the current model of psychotherapy – one-on-one face-to-face meetings between a trained professional provider and an individual client – is simply unsustainable in the face of rising rates of mental illness among increasingly diverse populations and rising costs of care. Ever since the article was published professional listservs have buzzed with discussion and the journal decided to publish a series of commentaries. Continue reading

Why To Exercise Today: It Even Helps Therapy

In junior high, my dear friend Stacey and I instituted a practice that we called the walk-and-talk. We would walk around the streets of our neighborhood discussing topics of burning importance — including which boys we considered “bush babies,” that is, attractive enough to want to meet with in the relative privacy of the bushes.

‘Many people skip the workout at the very time it has the greatest payoff.’

So “The Exercise Effect” in this month’s Monitor On Psychology from the American Psychological Association struck a major chord. It begins:

When Jennifer Carter, PhD, counsels patients, she often suggests they walk as they talk. “I work on a beautiful wooded campus,” says the counseling and sport psychologist at the Center for Balanced Living in Ohio.

Strolling through a therapy session often helps patients relax and open up, she finds. But that’s not the only benefit. As immediate past president of APA’s Div. 47 (Exercise and Sport Psychology), she’s well aware of the mental health benefits of moving your muscles. “I often recommend exercise for my psychotherapy clients, particularly for those who are anxious or depressed,” she says.

Unfortunately, graduate training programs rarely teach students how to help patients modify their exercise behavior, Carter says, and many psychologists aren’t taking the reins on their own. “I think clinical and counseling psychologists could do a better job of incorporating exercise into treatment,” she says. Continue reading

Can A Computer Program Help Your Angst?

My five-year-old fell off a chair last week and got a fairly significant bump on her head. I was anxious all night, checking her every few hours to make sure she hadn’t damaged her little brain. My husband slept (except for the times I woke him to vent my worry).

I asked him later how he managed to contain his anxiety, when mine had run amok. He said he takes a rational approach: he focuses on finding solutions to the things he can control, and tries not to get caught up in the things he can’t.

Which is why it makes perfect sense to me that a small study out of Brown University found that anxiety-plagued people who underwent “computerized anxiety therapy” — they were set up on computers with a program to help divert their attention from worrying and instead focus calmly on completing a specific task — grew less anxious. This so-called “cognitive bias modification” worked about as effectively as in-person talk therapy or drugs, researchers report.

Here’s the full press release from Brown:

A small clinical trial suggests that cognitive bias modification (CBM), a potential anxiety therapy that is delivered entirely on a computer, may be about as effective as in-person therapy or drugs for treating social anxiety disorder. The Brown University-led research also found that participants believed the therapy to be credible and acceptable.

Participants in the pilot study, published in advance online in the journal Depression and Anxiety, improved their scores on a standardized measure of anxiety and on a public speaking task after completing two simple exercises twice a week for four weeks. Continue reading