Computer-assisted psychotherapy (CAT) for depression

Introduction

Computer-assisted psychotherapy (CAT) for depression is developing rapidly. Several existing software programs can carry out many of the therapeutic tasks involved in depression treatment. Such programs help users to detail their problems, draw up a day-to-day treatment plan specific to their needs, rate their progress, practice coping with setbacks and do relapse prevention.  

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The prospect of using computers to deliver psychotherapy has been intriguing a number of investigators who have been studying innovative methods of bringing technology into clinical practice. The most dramatic form of CAT is virtual reality exposure therapy in which patients are immersed in a virtual environment to help extinguish fears of flying, heights, social situations, or other anxiety-provoking situations. Other commonly used CAT methods are multimedia applications that use video, audio, and interactive exercises to convey therapy concepts and to build coping skills. Handheld devices encourage patients to monitor themselves and to use behavioral methods to manage symptoms.

Computer-assisted psychotherapy programs are often based on cognitive-behavioral therapy (CBT) what is then called computerized CBT (CCBT). Anxiety and other mental health disorders can also be treated with computer-assisted psychotherapy. 

Benefits and Challenges

An important argument for using computers in psychiatric treatment is the possibility that effective software could have a significant positive impact on cost and availability of mental health services.” It was noted that the number of patients with Axis I disorders who could benefit from psychotherapies with demonstrated effectiveness far outstrips the pool of available therapists. It has also been observed that many distressed individuals do not receive therapy for their disorders. For example, more than one-half of individuals with major depression do not enter treatment. Several possible impediments to receiving treatment have been described, including insufficient financial resources, negative attitudes about psychiatric illnesses, and lack of access to therapy.

If computer tools could be used to decrease the amount of therapist time required for successful treatment, more patients could be treated with available resources. Access to therapy could be influenced through
1) reduced cost of services,
2) provision of computerized therapy in settings outside the therapist’s office (home, school, or work), and
3) provision of alternative therapies that might reach individuals who do not seek treatment through ordinary channels.

It has been noted that some patients may find it more acceptable to work with a computer (or a computer assisted treatment program that combines computerized therapy with visits to a clinician) than engage in traditional clinician-administered.

The rationale for computer-assisted therapy also draws on the unique features of computers that could prove to be advantageous in treating psychiatric disorders. Potential strengths of computer-assisted therapy programs are listed below. One possible asset of computer programs may be an ability to engage patients in the treatment process. The predictions of traditional therapists that patients will refuse computer-assisted treatment or have a negative response to being referred to a “machine” have not been borne out by actual experiences. Patients typically enjoy working on computers and report that the experience is beneficial.  Newer programs have used features such as multimedia, virtual reality, interactive voice response, and portable palmtop computers to create stimulating and engaging therapeutic experiences.

Although some of the early investigations of computerized therapy focused on programs designed to substitute for clinician administered treatment, most contemporary research has been directed at finding ways in which computers can assist therapists or enhance the therapy process.  Instead of pitting machine against human therapist, these investigators have suggested that clinicians can learn to incorporate computer tools into their practices to improve the overall therapy experience.

So, computer-assisted therapy may offer a solution of providing cost-effective psychological services to individuals experiencing barriers to treatment. Although in computer-assisted psychotherapy a human touch is missing, computers have significant strengths that can be used to advantage in depression treatment:
  • earlier access to treatment,
  • more treatment time than clinicians can usually give,
  • ease of treatment scheduling at home,
  • lower treatment cost,
  • confidentiality is greater and stigma avoided,
  • consistency of treatment instructions is greater,
  • self-help enhances a sense of control over one’s own destiny,
  • built-in outcome measures and systematic feedback.
Clinical applications

Although currently available, CAT programs have been effective in research studies; they have limitations in clinical practice. CAT programs do not perform full psychiatric assessments, make diagnoses, or develop comprehensive treatment plans; nor do they screen for and manage impulsivity or other potentially dangerous behavior, such as suicidality. And, of course, they cannot display the empathic concern, wisdom, flexibility, and creativity of human therapists. Thus, in clinical applications, CAT programs appear to be best suited as components of an overall treatment strategy that is prescribed and guided by a professional.

CAT is just beginning to take hold in psychiatric practice. Although a vigorous effort is under way to produce and test programs for psychiatric treatment, and the use of computers in society is steadily increasing, most clinicians are either unfamiliar with CAT or have not yet tried to use these programs to augment traditional therapy. The time may be near when clinicians who want to use technology in psychotherapy will have access to useful and effective programs that can enhance learning, make treatment more efficient, and bring a valuable new dimension to the psychotherapeutic process.

Therapists of the future may be able to conduct their daily work with a variety of empirically tested computer tools. These adjuncts could be completed before or after a session, either in waiting rooms or at home, or even in specially designed therapy suites that provide advanced technology (such as virtual reality and fully realized multimedia treatment programs). Further development of port­able devices that have better function­ality and connectivity, that offer more realistic and engaging programming, and that weave together the human and technological components of treatment could provide a myriad of opportunities for realizing the promise of the computer as a therapeutic “assistant.”



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