Virtual Therapy – Wave of the Future?
Depression is a mood disorder characterized by the absence of a positive effect, low mood, and various associated emotional, physical, cognitive, and behavioral symptoms. Associated symptoms include sadness, pessimism, loss of interest, changes in sleep, decreased appetite, and decreased motivation. New technology has allowed depression to now be treated by way of computer. European countries are actively promoting the use of various software programs and this evolving treatment modality is popping up more and more in the research literature. Is it the wave of the future? Can people actually treat themselves with the aid of technology? Around any new innovative treatment lingers controversy. The concept of computerized cognitive behavior therapy (known as CCBT) is an interesting topic among mental health professionals. Many therapists simply don’t believe it works while others question its acceptability with their patients. Many do not initiate it because they don’t know enough about it. But many fear it as a replacement. Man versus machine – advancing technology is much like a rose with many thorns.
Cognitive behavioral therapy (CBT) is based on the premise that inaccurate beliefs and maladaptive information processing have a casual role in depression and anxiety. It was developed by Aaron Beck in the 1960’s and in 1979 he and his colleagues had developed a detailed treatment manual for CBT. The aim of this treatment is to help patients acquire the abilities to identify the thought and images that accompany and precede the experience of upsetting emotions, distance themselves from the beliefs implied by these thoughts and images, question these beliefs for validity, and identify the themes in the content of these thoughts and images.
There are now over 100 computer-aided psychotherapy systems identified worldwide, many of them delivering CBT. One review found 97 different ones from nine countries when 175 studies were evaluated. The first one burst onto the therapy scene in the 1980’s, was developed by Dr. Selmi and associates, and was proven to be effective. This virtual therapy offers an alternative for depressed people who refuse therapy due to stigma, cost, or convenience issues. Most CCBT programs offer weekly sessions of around 40 – 50 minutes that involve cognitive restructuring without human contact. Minimal support by a mental healthcare professional is required. These programs focus on changing automatic thoughts and core beliefs to assist learning and retention. In addition, most computer-based therapy offers an introductory session involving psychoeducation, and then a final session on relapse prevention. Various types are available and can include email or phone contact with a therapist and direct feedback to the user as well. There are free online programs including Mood Gym by the Australian National University and myRay by Dr. Michael Benjamin.
Depression has been noted by the World Health Organization to be a significant public health problem with lifetime prevalence from 4.9% to 17%. Due to the shortage of licensed trained cognitive behavior therapists, this emerging intervention offers a cost-effective solution for those on waiting lists for therapy treatments. Cost analysis and economic research tells us that virtual therapy not only has proven clinical effectiveness, but cost effectiveness as well. The enormous burden that depression places on the healthcare delivery system and society can be lessened through CCBT utilization. Because of the accessibility of the treatment and its advantages of privacy and time conservation, CCBT is a promising solution to the under treatment of mild to moderate depression.
DeRubeis, R., Siegle, G., & Hollon, S. (2008). Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms Nature Reviews Neuroscience, 9 (10), 788-796 DOI: 10.1038/nrn2345
Gerhards, S. de Graaf, L., Jacobs, L., Severens, S., Huibers, M., Arntz, A., Riper, H., Widdershoven, G., Metsmakers, J., & Evers, S. (2010). Economic evaluation of online computerized cognitive behavioral therapy without support for depression in primary care: randomized trial. The British Journal of Psychiatry, 196, 310-318. PMID:20357309
Green, K., & Iverson, K. (2009). Computerized cognitive-behavioral therapy in a stepped care model of treatment. Professional Psychology: Research and Practice, 40 (1), 96-103 DOI: 10.1037/a0012847
Marks IM, Cavanagh K, & Gega L (2007). Computer-aided psychotherapy: revolution or bubble? The British journal of psychiatry : the journal of mental science, 191, 471-3 PMID: 18055948
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys The Lancet, 370 (9590), 851-858 DOI: 10.1016/S0140-6736(07)61415-9
Bates B, Choi JY, Duncan PW, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D, Zorowitz R, US Department of Defense, & Department of Veterans Affairs (2005). Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: executive summary. Stroke; a journal of cerebral circulation, 36 (9), 2049-56 PMID: 16120847
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