When Your Therapist Is a Computer
Experts say digital programs can help enhance the effects of traditional therapy or reduce the amount of time needed with an in-person therapist. (Getty Images)
Each time Andy Strunk stood up to give a work presentation, the same few doubts ran through his head. “Am I qualified to be in front of these people? Who am I? Why am I credible to be here?” worried Strunk, a 37-year-old marketing manager at a technology company in San Francisco.
But about a month ago, Strunk decided he had had enough. To progress in his career, he would need to tackle his public speaking fears now. “I don’t want to have my life dictated by this thing that is anxiety,” he says. So Strunk began seeing a psychologist. who is using a form of treatment called cognitive behavior therapy, or CBT, to help Strunk catch the negative thoughts before they begin – and replace them with the truth. “I’ve rewired my thinking to say, ‘I am credible to be here,'” says Strunk, who mentally lists his accomplishments before taking the stage.
Strunk’s experience is representative of CBT, which focuses on “examining the relationships between thoughts, feelings and behaviors,” according to the National Alliance on Mental Illness. Rather than laying on a couch facing away from a therapist and delving into your subconscious and past, CBT is a collaborative effort between the patient and mental health professional aimed at improving life in the here and now.” CBT focuses on teaching people skills so they can learn to be their own therapists,” says Judith Beck, president of the Beck Institute for Cognitive Behavior Therapy and clinical associate professor of psychology at the University of Pennsylvania.” Usually, these are skills to help people change their inaccurate or unhelpful thinking and to change their unhelpful behavior.”
While CBT may not work for all mental illnesses or may need to be combined with medications for some people, Beck says close to 2,000 studies support its effectiveness for treating all kinds of conditions, including mood disorders, substance abuse, eating disorders. marriage and family problems, and even severe mental illnesses like schizophrenia. It can work for all ages and in a variety of settings, such as schools and hospitals. “We don’t really yet know what CBT – appropriately modified – isn’t effective for,” Beck says.
For Strunk, the therapy is a welcome alternative to the anxiety-reducing and sleep-inducing pills his internist originally prescribed. “It feels like I’m a little bit more in control of things that would typically go unchecked in my head,” he says. “That’s what I was after.”
While Strunk has found the therapy sessions to be useful, he says they don’t allow as much time for the educational component of CBT as he’d like. So he’s also using an interactive computer program called Good Days Ahead to learn more about anxiety, how CBT works and to digitally track his moods and thought patterns. “It gives me a source of data that I plan now to introduce into the work that I’m doing with the therapist,” says Strunk, who learned about the program through his friend Eve Phillips, the CEO and co-founder of Empower Interactive, the company that launched Good Days Ahead.
Online and computer-based CBT programs are nothing new, but today, “there are numerous treatment programs on the Internet and even more apps,” says Gerhard Andersson, a professor of clinical psychology at Linkoping University in Sweden. “The number increases every day.” Phillips says her company’s program is one of about a dozen on the market, and one of dozens if you include programs being developed and studied.
Some programs including Good Days Ahead and one of the oldest and most widespread programs, Beating the Blues. work with practitioners and businesses like insurance companies, while others are available directly to consumers, usually for a fee. Good Days Ahead typically costs between $50 and $150 per person, depending on the setting, features and type of consumer, Phillips says. A different online CBT program specifically for social anxiety, Learn to Live. costs $150 for eight lessons.
Experts say computer-based CBT programs like Good Days Ahead can help boost the effects of traditional therapy or reduce the amount of time needed with an in-person therapist. The programs – which may consist of educational modules, video tutorials and tools like apps and spreadsheets that help track moods and behaviors – also offer help to people who don’t have physical or financial access to a therapist, or for whom the idea of seeing a therapist is too anxiety-provoking. “You don’t have to travel, you don’t have to get a baby sitter, you don’t have to pay as much money. You can do it at a convenient time,” Beck says.
Most important, many of the programs are effective. For instance, one study published last year compared face-to-face CBT to Internet CBT for conditions including panic disorder, male sexual dysfunction and spider phobia and found both routes to be equally effective. “When guidance is given online,” Andersson says, “CBT tends to be as effective as seeing a therapist, at least for mild to moderate problems of anxiety and depression.”
Finding an Effective Program
Just like there are poor clinicians, there are less effective computer-based CBT programs, Andersson says. That’s why it’s important to make sure you choose a program carefully. First, ask yourself if the nature of your problem is appropriate for computer-based therapy, especially if you’re planning to use it without the assistance of a professional, says Linda Campbell, a professor of counseling psychology at the University of Georgia and co-chair of a Task Force for Telepsychology Guidelines. If you get anxious about taking tests, for example, a computer-based program may work well because it can suggest tangible skills for you to practice, such as sitting in the test room every day and imagining feeling relaxed and confident. In that case, be sure to look for a program that has been studied, requires a diagnostic checkup and offers support from a clinician, Andersson suggests.
If you’re severely depressed. on the other hand, a computer-based program may not suffice. “Depression is rarely in a person’s control,” and so the steps introduced in computer programs alone may not be enough to treat it, Campbell says. What’s more, if someone is suicidal. not having contact with a professional who can monitor him or her can be dangerous, Beck adds. Other potential downfalls to using only computer-based programs for treatment include higher dropout rates and difficulty tracking outcomes. “We want to make sure that people who are engaged in the program do recover,” Beck says.
For Strunk and others, an approach that combines computer-based and in-person CBT is the best way to go. “It’s a good adjunct to whatever therapy you’re going through,” Strunk says. Research supports his experience. One meta-analysis from the University of Pennsylvania and the University of Louisville Depression Center, for instance, reviewed 29 studies of computer-assisted CBT and found that people with depression improved more if their program offered telephone or in-person support from a therapist. “Many prefer to see a therapist in person, and for some, it is the other way around,” says Andersson, who was not involved with the study. “But do not forget that in the future we will not be forced to choose. Rather, online and face-to-face will be mixed to get the best of both worlds.”
A combined approach also has benefits for the health care system, says one of the study authors, Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine and the Philadelphia Veterans Affairs Medical Center. In a different study of 154 people with major depressive disorder, Thase and his colleagues found that those assigned to a 16-week treatment that included both forms of CBT, rather than only traditional CBT, reduced the time spent with a clinician by one-third – with no difference in outcomes.
Reduced clinician time is something worth cheering for since the ratio of mental health providers to people in the U.S. is 1:790, and less than half of people with a mental health issue report receiving treatment, according to Mental Health America. ”There are so many more suffering people than there are therapists,” Thase says. “It’s not a threat [to our profession] – it’s a complement.”