Monday, August 24, 2009

Online Cognitive Behavioral Therapy effective when delivered in real time by a therapist

Online therapy or “eTherapy” has been provided by some therapists in a number of different ways, ranging from email, to computerized therapeutic programs (one to be posted here soon), to real time video, for over 10 years. A brief history from 1972-2002 can be found at http://www.metanoia.org/imhs/history.htm

A number of questions remain fully unanswered. Probably the most critical question is how to ensure confidentiality. Additionally, there are questions of how effective these interventions are.

A study in England looked at 297 adults who were diagnosed with depression. Half of these people (149) received online cognitive-behavioral therapy and “usual care” (presumed to mean anti-depressant medication) and half (148) received “usual care” from their general practitioner while on an 8-month waiting list for online CBT. At fourth months, 113 in the CBT group and 97 in “usual treatment” completed a four month follow-up, where 38% of the CBT group were considered recovered from depression compared to 24% of the second group. There was a small increase at eight months to 42% for the CBT group and 26% of the second group.

The authors conclude: “The number of patients for whom online CBT is feasible and attractive will grow. It could be useful in areas where access to psychological treatment is scare, and for patients whose first language is not English. It could make access to psychotherapies more equitable by providing a service to patients in areas or even countries where psychological treatment is not readily available. Real-time online CBT offers the flexibility and responsiveness of face-to-face CBT and is appropriate for people with severe symptoms. It affords an opportunity for reflexion and review as part of the therapeutic process, which could enhance its effectiveness.”

There are some limitations to this study. There was no no-treatment control group. The summary did not report how much improvement there was or was not in the majority of people who were not considered “recovered.” It is also unclear whether online CBT would be as effective as in-person treatment. Many questions for further studies.

For a summary of the study http://www.bristol.ac.uk/news/2009/6502.html.

Best wishes,

Mike

http://drmikemiller.com/depression.html

1 comment:

Leo said...

At this point it is clear that Online Therapy works. The Moodgym is the oldest example of course. There were studies done on eliza AI system in the seventies that showed it helped.

But it helped means they may have not had clinical/chemical depression. I know that mood shifting can happen with these tools. I use a new one http://www.clarifylife.com
It seems to be the new age way of therapy.
I would prefer one to one counseling with a person but I can't afford it.
Bottom line, this stuff works no matter how many studies are done.

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