Monday, October 8, 2007

Technological Treatments: Can Computer Programs Cure Phobias?

In a world connected by technology it is no surprise that people suffering from phobias are now turning to computers to cure them of their fears. MSNBC recently published an article explaining that in Britain, general practitioners are issuing passwords allowing their patients to access computer programs that mimic sessions with psychiatric counselors. The computerized cognitive behavior therapy program mainly works to teach patients new ways to think or react in order to alter their fearful behavior and emotions. Many believe that these programs are a great innovation because patients in Britain often struggle to get appointments with their therapists. Although it sounds like this new technology is capable of helping many, it may not be suited for everyone and could possibly fall short in providing adequate treatment to all patients.

The computer therapy does offer many advantages to patients suffering from phobias. In one of the programs called FearFighter, patients are taught to recognize the signs that trigger their panic attacks in order to prevent future attacks and they are also taught how to deal with their fears. People living with phobias are not the only ones encouraged to use FearFighter. Individuals with obsessive compulsive disorder, post traumatic stress disorder, depression and sleep disorder are all urged to use the program as well. Another clinically proven computer program, Beating the Blues, is also being recommended to combat anxiety and depression.

Both the National Institute for Health and Clinical Excellence (NICE) and the Department of Health in the United Kingdom have previously published reviews that offer guidance to using computerized cognitive behavior therapy programs. These reviews proved that the computerized programs were not recommended to treat such a wide range of disorders. For example, when it came to obsessive compulsive disorder, NICE was unable to recommend any computerized program for treatment. When it came to depression, Beating the Blues was only recommended for mild and moderate depression, and not severe depression. Therefore, not everyone will be able to benefit from these computerized programs. Furthermore, recommending a computerized cognitive behavior therapy program to a depressed patient may not be so beneficial because they may actually need to be prescribed medication and only a certified practitioner can do that. Depressed patients may in fact benefit more from interacting with a therapist than from interacting with a computer screen because an interpersonal relationship is formed. The therapists can also be more beneficial in letting their patient know that social support is seen to be essential in dealing with emotional pain.

By relying solely on the computerized CBT, patients suffering from phobias may also be missing out on other successful treatments that occur specifically in therapists’ offices, such as systematic desensitization and exposure therapy. In systematic desensitization the patient is taught various relaxation skills and together with the therapist they develop a hierarchy of anxiety-provoking situations. Someone who is afraid of spiders, for example, might start off by looking at a picture of a spider (see image above) and they then go on to apply these relaxation techniques to this fear inducing situation. However, these are techniques that work better if conducted with the supervision of a therapist. In exposure therapy, the therapist helps the patient overcome their phobia by exposing them to the stimuli that actually frightens them. Sometimes exposure therapy might involve reliving a traumatic event in a controlled, therapeutic environment. Exposure therapy has helped many trauma victims overcome PTSD and this just goes to show how interaction with therapists may prove to be better than interactions with computers.

Computerized CBT programs undeniably work well to help individuals deal with their phobias and depression. In Britain, a few thousand people are estimated to have already been treated with the programs. However, CBT should not in any way be used to replace real therapy conducted with a therapist because patients may miss out on other valuable components of therapy.

2 comments:

LG said...

Dear IC- This is a very interesting post, I have never heard of computers being used to battle different phobias. Where did the idea of using computers to help phobia patients derive from? “People suffering from phobias are not the only ones encouraged to use FearFighter. Those suffering from obsessive compulsive disorder, post traumatic stress disorder, depression and sleep disorder are all urged to use the program as well.” It is great how the treatments are spreading out to a wider audience of people. I have worked with children that have severe to moderate disabilities and computers are used on a regular basis to help treat their symptoms. For example, computer games that require touching different objects with sensors on them help children that are tactile defensive. So although you say in no “…way be used to replace real therapy conducted with a therapist because patients may miss out on other valuable components of therapy,” I do think that different computer programs can be a great too and resource for patients to use on their own.

This is a very entertaining post and would love to hear about how successful the programs have been for patients. Is there any evidence available on the success rate? Also, how much does it cost to subscribe to a program like FearFighter? Is it free? Or must a patient have a prescription for a therapist to fully access the website?

One minor critique would be in the fourth paragraph when you say, “Someone who is afraid of spiders, for example, might start off by looking at a picture of a spider (see image above)…” the image is more to the left of the sentence. I enjoyed the pictures and I thought they were very relative to your post.

You wrote an excellent and informative post about a topic that is not well known.

AMC said...

This is such an interesting topic that I probably would have never heard of if it weren’t for your blog entry, and I thank you for bringing an innovative topic up for discussion. What I really liked about this post especially was that, even as a person who was completely unfamiliar with the topic at hand, the language you used and the way you made your argument was not lost on me. You write not only for your peers in your own field, but for others who may not be familiar with your career area, and that is very commendable. I also think that your choice in graphics is very effective, and that they further illustrate your points made in writing well.

I’d say, as far as the topic, I would definitely agree with what you are arguing. I do not ever see computer therapy replacing face-to-face interaction with a therapist. To me, the whole basis of therapy is that the patient is talking to someone in person, out loud, about his or her feelings and problems. A computer cannot talk back to a person or respond to her emotions, therefore, would be, in my opinion, useless as a form a therapeutic treatment. You did an excellent job arguing your opinions and thoughts in your writing, and it was very well done and a pleasure to read.

My only very minor critique is that you don’t make reference in writing to your first 2 images in the post (such as giving a short description and saying “as seen in the graphic…”). I believe doing this would make your images even more effective than they already are. But really, a great post overall.

 
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