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Thomas S. May, M.A.Medical Writer |
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Computer-Aided Psychotherapy: Will Phone Replace Couch?
Thomas S. May, Medical Writer
Introduction The mentally disturbed desperately need attention from someone kind and wise, but will something do instead? Interactive computer programs designed to diagnose and treat some mental disorders are becoming more and more popular, experts say. The latest in high-tech mental healthcare is computer-aided psychotherapy, called CAP for short. One such computer program, called COPE, lets depressed people dial up a sophisticated computer system and answer its questions using their telephone keypad. Based on the answers patients give, the computer rates how severe their depression is, suggests exercises that might help, and gives feedback on their progress. (See www.copewithlife.com/copedemoexplain.html for a demo.)
COPE is based on what's called cognitive-behavioral therapy. It uses guided exercises to help patients replace their distorted thoughts and inappropriate behaviors with more appropriate thought and behavior patterns.
"COPE was developed to help people who don't have the time, access, or finances for traditional psychotherapy," says John H. Greist, MD, one of the program's authors. "It's a complementary program for traditional psychotherapy, as well as a self-help tool for those who want to gain more control over their lives." According to Jay M. Pomerantz, MD, a lecturer on psychiatry at Harvard Medical School in Boston, "the next 10 years will see the flowering of this kind of self-administered, computer-assisted psychotherapy." HMOs and other managed care organizations will embrace the approach, he says, "because of its low cost and the need to do something with the increasing numbers" of patients with behavioral problems.
Pros & Cons Computer-aided psychotherapy has some advantages over the traditional face-to-face therapy you would receive in a therapist's office. Most mentally ill people never seek help for their problems, and one of the main reasons for this is the stigma that can come with being treated for mental illness. CAP helps patients past this obstacle because it's completely anonymous and can be used at home.
"Computer-administered psychotherapy is accessible to everyone who has a touch-tone telephone," Greist says. "Furthermore, the cost is low, and the treatment itself is highly standardized but personalized."
CAP does have its drawbacks, however. "Ultimately, a skilled therapist should be more sophisticated than the present computer programs," he says. Also, he warns, CAP isn't right for patients who are having a major depressive episode and are suicidal.
Does It Work? Although it's limited in some ways, CAP appears to work just as well as traditional psychotherapy for a number of common psychiatric problems. According to Brett A. Daniels, PhD, a lecturer on psychiatry at the University of Tasmania in Australia, CAP has been especially useful as a treatment for anxiety disorders in cases where the person using it can apply self-help therapy.
Depression and addiction are two other areas where CAP might be applied, Daniels says. "These disorders are notable in that they are well treated psychologically by cognitive-behavioral therapy."
Greist and his colleagues have done clinical trials comparing COPE to antidepressant medication and traditional psychotherapy. COPE worked just as well to reduce patients' scores on the Hamilton Depression Rating Scale (a standard measure of clinical depression) as a commonly used antidepressant drug did. It was also as effective as the various kinds of psychotherapy that doctors use, Greist says. BT STEPS is another CAP program. It lets patients communicate with a computer by telephone, and it was developed for the behavioral treatment of obsessive-compulsive disorder. A randomized, controlled trial involving about 200 patients in eight different locations showed that BT STEPS worked just as well as treatment provided by human therapists. What's more, dropout rates were significantly lower in the computer-administered therapy group than in the therapist-guided group (18% versus 27%).
Better Than Nothing Many experts say CAP will become more and more popular over the next few years. One reason, Greist says, is that "as the benefits of computer-assisted psychotherapy--especially its comparatively low cost--become clear, managed care companies will begin to support this method of treatment." But will using CAP more mean the end of human therapists? Probably not.
Daniels points out, for example, that anxiety disorders and depression affect up to 20% of people at some time in their lives, but very few of them get professional psychiatric treatment. At present there's a tremendous need for treatment--a need that is not being met, he says.
Individual psychotherapy will remain the most effective treatment for many patients who, for one reason or another, aren't right for CAP, Daniels says. But for most patients the choice will not be between CAP and traditional psychotherapy, but rather between CAP and no treatment at all. "Many of these patients live in places that are poorly served by mental health services and the services that are available may be expensive or difficult to access," Daniels says. "So I don't think that psychotherapists will have less work to do with the advent of computer-aided psychotherapy. Instead, its main effect will be to greatly increase the number of patients who receive any sort of treatment at all." For further information about--and examples of--CAP, visit these Web sites:
Thomas S. May is a medical
journalist based in Toronto, Ontario, Canada. He has a master's degree in
psychology from Simon Fraser University in Burnaby, British Columbia. Source: Medscape Health
Reprinted from Medscape Health for Consumers.
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