Computers, Internet and Psychotherapy
The demand of psychotherapy often exceeds the availability of therapists. Two studies published in the journal Psychotherapy and Psychosomatics review how modern computer and communication technologies can provide novel opportunities for the provision of stepped care for patients with mental disorders.
In a a review and an accompanying editorial by Prof. Isaac Marks and collaborators point out that therapist time is not saved by conducting cognitive behavior therapies (CBT) via e-mail, telephone or video-conference exchanges between patient and therapist in real time. However, time can be saved when treatment tasks are delegated to patient-computer interactions.
Many patients may also prefer to access CBT at home by computer for reasons of greater confidentiality, lessening of stigma and reduction of time needed to travel to a therapist.
This concept was explored by Indra Tumur and colleges in a analysis of 4 studies to compare the effectiveness of a computerized cognitive behavior therapy (CCBT) program, BTSteps, for the treatment for obsessive-compulsive disorder (OCD) against the traditional therapist-led cognitive behaviour therapy (TCBT) and relaxation.
They found that CCBT was as good as TCBT for reducing time spent in rituals and obsessions and and was superior to RLX treatment. Improvement of OCD persisted beyond the end of the CCBT treatment. Therapist guided CBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure.
In the third study, University of Heidelberg researchers investigated the effectiveness of group therapy delivered through an Internet chat room following inpatient treatment.
The main goal of the program was to reduce the risk of losing the therapeutic benefits gained during the inpatient treatment. 114 patients participated in one of two parallel groups of 8-10 patients that met with a group therapist in an Internet chat room.
The groups met weekly for 12-15 weeks for 90 min. Controls were 114 patients who did not participate in the chat groups and were matched by application of propensity score methods.
The main criterion was derived from comprehensive assessments of changes in health status comprising the psychological and physical condition of the patients.
Assessments were conducted at admission, discharge and 12 months after discharge. 12 months after discharge, chat participants showed a substantially lower risk (24.7%) for negative outcome than controls (38.5%). Furthermore, a low dropout rate and the high session attendance suggest this novel offer met patients' needs, and thus, opens new avenues for optimizing care for patients with mental disorders.
Baer L, Greist J, Marks IM. Computer-Aided Cognitive Behaviour Therapy Psychother Psychosom 2007;76:193-195 (no abstract)Tumur I, Kaltenthaler E, Ferriter M, et al. Computerised Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: A Systematic Review Psychother Psychosom 2007;76:196-202
[Abstract]
Golkaramnay V, Bauer S, Haug S, et al. The Exploration of the Effectiveness of Group Therapy through an Internet Chat as Aftercare: A Controlled Naturalistic Study Psychother Psychosom 2007;76:219-225 [Abstract]
In a a review and an accompanying editorial by Prof. Isaac Marks and collaborators point out that therapist time is not saved by conducting cognitive behavior therapies (CBT) via e-mail, telephone or video-conference exchanges between patient and therapist in real time. However, time can be saved when treatment tasks are delegated to patient-computer interactions.
Many patients may also prefer to access CBT at home by computer for reasons of greater confidentiality, lessening of stigma and reduction of time needed to travel to a therapist.
This concept was explored by Indra Tumur and colleges in a analysis of 4 studies to compare the effectiveness of a computerized cognitive behavior therapy (CCBT) program, BTSteps, for the treatment for obsessive-compulsive disorder (OCD) against the traditional therapist-led cognitive behaviour therapy (TCBT) and relaxation.
They found that CCBT was as good as TCBT for reducing time spent in rituals and obsessions and and was superior to RLX treatment. Improvement of OCD persisted beyond the end of the CCBT treatment. Therapist guided CBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure.
In the third study, University of Heidelberg researchers investigated the effectiveness of group therapy delivered through an Internet chat room following inpatient treatment.
The main goal of the program was to reduce the risk of losing the therapeutic benefits gained during the inpatient treatment. 114 patients participated in one of two parallel groups of 8-10 patients that met with a group therapist in an Internet chat room.
The groups met weekly for 12-15 weeks for 90 min. Controls were 114 patients who did not participate in the chat groups and were matched by application of propensity score methods.
The main criterion was derived from comprehensive assessments of changes in health status comprising the psychological and physical condition of the patients.
Assessments were conducted at admission, discharge and 12 months after discharge. 12 months after discharge, chat participants showed a substantially lower risk (24.7%) for negative outcome than controls (38.5%). Furthermore, a low dropout rate and the high session attendance suggest this novel offer met patients' needs, and thus, opens new avenues for optimizing care for patients with mental disorders.
Baer L, Greist J, Marks IM. Computer-Aided Cognitive Behaviour Therapy Psychother Psychosom 2007;76:193-195 (no abstract)Tumur I, Kaltenthaler E, Ferriter M, et al. Computerised Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: A Systematic Review Psychother Psychosom 2007;76:196-202
[Abstract]
Golkaramnay V, Bauer S, Haug S, et al. The Exploration of the Effectiveness of Group Therapy through an Internet Chat as Aftercare: A Controlled Naturalistic Study Psychother Psychosom 2007;76:219-225 [Abstract]
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