October 2005, Vol. XXII, Issue 12
The role of technology in health care has taken a prominent role in many different specialties including psychiatry. Psychotherapists are using virtual reality to treat posttraumatic stress disorder (Kaplan, 2005). Many mental health clinics have Web sites with online screening tools for depression and anxiety. A few practices are offering online appointment scheduling as well. Electronic medical record systems provide reminders and alerts for lab tests and critical values. There are still many new technological innovations that have potentially groundbreaking implications in the future such as nanotechnology. However, this article will focus on the two technologies that will certainly play a significant role in the future--computer-based therapy and radio frequency identification (RFID).
Many patients with depression or anxiety first seek medical care with their primary care physicians. After a few trials of antidepressant or anxiolytic medications, the primary care physician will make a referral to the psychiatrist for the more difficult cases. Some patients will obtain traditional psychotherapy and medication treatment. However, there are significant numbers of patients who will not seek mental health care. These patients often turn to self-help materials available online or in the bookstore. With today's sophisticated computers and the large amount of storage available on DVDs, computer-based assessment and treatment software is becoming more commonplace.
These programs are quite sophisticated, utilizing specialized heuristic techniques to produce a more natural response to patient-entered information. Natural language processing allows software to determine the nature of queries and responses. Most programs use a cognitive model of treatment, since a more structured therapy lends itself to programming. These software programs present several key concepts, such as the relation between automatic thoughts and feelings, and highlight techniques to control these thoughts. These programs utilize multimedia with audio and video to enhance the experience. They have the ability to store responses to exercises, which creates a more personalized experience and allows the user to proceed at a comfortable pace. Many of the programs implement rating scales to assess depression or anxiety in order to provide feedback. Ratings may also determine the next module for treatment or recommendations for other exercises. Several computer-based therapy Web sites are listed in the Table.
There are numerous advantages to computer-based therapy. Patients can work at their own pace in the privacy of their own home. There are no social cues and dynamics of relationships as in psychotherapy, so patients may disclose feelings that they would normally feel uncomfortable sharing. Patients with panic attacks may benefit since they may initially not be able to travel to therapy. In addition, software programs are not susceptible to the frustrations of traditional treatment such as changed appointments, therapist boredom, absences and ethical misconduct.
Patients have a more active learning role while using a program versus the potential role as dependent in therapy, thereby providing a sense of empowerment. Treatment is accessed with a minimum of delay, and the programs are quite affordable.
Although almost all patients should benefit from self-help, there is a small subset that will not benefit from computer-based therapy. They may be too depressed or anxious in order to focus on the material, which could be exacerbated if they are unable to navigate the program. Age, personality and adaptability play a role in predicting which patients may benefit from self-help treatments. In addition, factors such as poor eyesight, reading skills and computer proficiency may affect use of computer-based therapy. Many patients may not be able to afford sufficiently powerful computers or have a fast enough Internet connection to run these programs.
The literature supporting the effectiveness of computer-based therapy has been growing. One of the first studies compared a six-session, computer-based version of cognitive-behavioral therapy (CBT) with six sessions of therapist-administered CBT and a waiting list control group (Selmi et al., 1990). In this study, both treatment groups were significantly improved on the Beck Depression Inventory (BDI) and the Automatic Thoughts Questionnaire, with no difference between the treatment modalities. Patients at a community mental health center who were waiting for CBT were offered an opportunity to use computerized CBT (van den Berg et al., 2004). This study demonstrated improvements in well-being, problems and functioning in the Clinical Outcomes in Routine Evaluation Outcome Measure, a self-report questionnaire with sub-domains for subjective well-being, problem/symptom severity, life functioning, and risk to self and others. Even use of computer-based therapy in the general practitioner's office has been demonstrated to be effective with significantly lowered ratings on the BDI, Beck Anxiety Inventory, and Work and Social Adjustment Scale (Proudfoot et al., 2003).
Computer-based therapy programs offer many benefits with limited risks. While they are not touted as replacements for traditional therapy, they are very useful supplements. More studies are needed to determine the level of therapist involvement to produce better outcomes for patients using these programs.