Free online computerized cognitive-behavioral therapy for depression

Free? Then can it be worth much? Ah, that might depend on how hard you work. This is working with a computer, not a human.

Mind you, this may not work as well as seeing a real live therapist who knows the CBT approach well. But lots of people can't get real live CBT, because they:

• Can't afford it


• Can't find it


• Don't like the whole idea of telling someone their problems (guys?)


• Think they've already had it (but haven't)

So, if there was a way to get cognitive therapy for free, that would be pretty nifty. Well, there is.

What is MoodGYM?

MoodGYM is an innovative, interactive web program designed to prevent depression. It consists of five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment.

Using flashed diagrams and online exercises, MoodGYM teaches the principles of cognitive behavior therapy – a proven treatment for depression. It also demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques.

MoodGYM was designed and developed by staff at the Centre for Mental Health Research at the Australian National University, in collaboration with other researchers, mental health experts, web and graphic designers, and software engineers.

Each module explores issues such as:

• why someone feels the way they do,


• changing ‘warped’ thoughts,


• changing the way they think, 


• knowing what makes an individual upset,


• assertiveness and interpersonal skills training.

History

This idea originated, in a way, not with the internet but with another technology: telephone-based "interactive voice response" (IVR). Trying to make CBT more widely available, a team of researchers created an IVR system of therapy. I never got to try it, but apparently it worked as well as a live therapist.  Then, an intermediate form of computer-assisted therapy was tested at Harvard, in which a computer program was used to deliver some of the basic explanations and planning of CBT.  Therapist time was reduced accordingly. This worked as well as standard, "live" therapy. Now, there is a program in which all of your interaction is with your computer, none with a human.

Warning

Here are several ways in which this free program could harm you:

• You try it, it doesn't work, and you conclude cognitive behavioral therapy doesn't work for you. Don't do that.


• You try it, raise your hopes, it doesn't seem to help, you feel disappointed (especially if you tried hard)


• You try this instead of a good, live therapist whom you could go see, within a few weeks, when you could afford it.


• You stay up too late at night on your computer doing this homework instead of sleeping!

There is no evidence that this computer approach is better than a live therapist.  So since we know that good live CBT really works; and since we don't have a head-to-head comparison of computer versus live therapist yet; for now, you should only use this approach if for some reason it's clear: you need additional antidepressant help, and you are not going to be able to see a good, live therapist.

Why should you try it? If you really, for any reason, can't get CBT some other way; and if you need to add an additional antidepressant element into your treatment, and you want with all your hurt to make it work, the program might be quite useful for you and will help your recovery.  

Technical Requirements

Before using MoodGYM, please make sure that:

• You have the flash 4.0 plug in (so that you can view graphics)


• JavaScript is enabled (so that you can view extra content)


• 'Cookies' are enabled (so that you can log in). If necessary, you can enable cookies using your browser's Help utility. Cookies are temporary and are deleted when you close your browser.

MoodGYM makes frequent use of multimedia presentations and graphics. If you are visually impaired, you may be using browser software that is unable to display some of this material.

Interface Languages

English and Norwegian

Cost

The program MoodGym is free and anonymous for all users. And there are no ads!

Website: Website: http://moodgym.anu.edu.au/welcome

Good Days Ahead: The Interactive Program for Depression and Anxiety

After reading self-help books based on cognitive therapy I decided to apply my new skills. Instead of doing exercises on paper I wanted to have them organized and easily accessible on my computer so I was looking for a computer program to help me. Good Days Ahead has helped me with that and much more - it helped me recognize my automatic thoughts and track my depression and anxiety level. After several weeks the program has shown that my mood improved and I was able to feel it too! Despite minor technical shortcomings multimedia features of this program make using it fun and easy.

Peter Toll

Good Days Ahead is the first computer program to combine the power of interactive multimedia with scientifically tested therapy methods for fighting depression and anxiety. This innovative self-help program gives you practical tools for building self-esteem, controlling your moods, and coping with stress.  Good Days Ahead is full of engaging videos and empowering self-help exercises.  The program is designed to help you tap your inner strengths to overcome your problems.

The program has a number of interactive scenarios designed to promote discovery of the patients inner strengths and is especially helpful in teaching users core beliefs because it is using highly stimulation multimedia learning experience that can point the way to cognitions, not apparent on the surface. Also, this computer-assisted CBT employs learning enhancement techniques that promote rehearsal and recall.

In a controlled study of computer-assisted CBT versus standard CBT, it was found that patients who use the Good Days Ahead computer program had greater improvement in scores on the Dysfunctional Attitude Scale than those who received standard CBT.



Written by leading experts, including Jesse H. Wright, M.D. (author of Getting Your Life Back: The Complete Guide to Depression) and Aaron T. Beck, M.D. winner of the Heinz Award and author of many acclaimed books including Cognitive Therapy of Depression) this computer program brings you the best self-help methods for depression in an easy-to-use, interactive format.

Features of Good Days Ahead





- Helps you take action now to solve problems and start feeling good again

- Teaches you how to change negative thinking and become a more effective person

-  Based on clinically proven methods from cognitive therapy

- The most extensively tested non-drug treatment for   depression and anxiety.

- Measures your moods and keeps track of your progress

- Highly realistic videos demonstrate ways to overcome depression and anxiety

- Interactive exercises help you gain skills in using the effective self-help methods of cognitive therapy

- Engaging and easy to use multimedia format on DVD-ROM

Hardware





The Good Days Ahead DVD-ROM requires a personal computer with a 500MHz Pentium III series (or above) processor, 64MB RAM, 300MB available hard drive space, a DVD-ROM drive, sound card, and a set of external speakers or headphones.

Note: This program will not work on a DVD video player or a computer with a CD-ROM drive only.

Authors

MindStreet™ is a multimedia company that focuses on development of interactive computer programs for behavioral medicine. The goal of MindStreet™ is to provide multimedia self-help programs that can improve the quality and cost-effectiveness of behavioral health care.

Demo

You can get a feeling if this software is right to you, checking the Demo session on the company website: http://www.mindstreet.com/.

Cost

Cost of the program is $70.

Computer-assisted psychotherapy (CAT) for depression

Introduction

Computer-assisted psychotherapy (CAT) for depression is developing rapidly. Several existing software programs can carry out many of the therapeutic tasks involved in depression treatment. Such programs help users to detail their problems, draw up a day-to-day treatment plan specific to their needs, rate their progress, practice coping with setbacks and do relapse prevention.  

1

The prospect of using computers to deliver psychotherapy has been intriguing a number of investigators who have been studying innovative methods of bringing technology into clinical practice. The most dramatic form of CAT is virtual reality exposure therapy in which patients are immersed in a virtual environment to help extinguish fears of flying, heights, social situations, or other anxiety-provoking situations. Other commonly used CAT methods are multimedia applications that use video, audio, and interactive exercises to convey therapy concepts and to build coping skills. Handheld devices encourage patients to monitor themselves and to use behavioral methods to manage symptoms.

Computer-assisted psychotherapy programs are often based on cognitive-behavioral therapy (CBT) what is then called computerized CBT (CCBT). Anxiety and other mental health disorders can also be treated with computer-assisted psychotherapy. 

Benefits and Challenges

An important argument for using computers in psychiatric treatment is the possibility that effective software could have a significant positive impact on cost and availability of mental health services.” It was noted that the number of patients with Axis I disorders who could benefit from psychotherapies with demonstrated effectiveness far outstrips the pool of available therapists. It has also been observed that many distressed individuals do not receive therapy for their disorders. For example, more than one-half of individuals with major depression do not enter treatment. Several possible impediments to receiving treatment have been described, including insufficient financial resources, negative attitudes about psychiatric illnesses, and lack of access to therapy.

If computer tools could be used to decrease the amount of therapist time required for successful treatment, more patients could be treated with available resources. Access to therapy could be influenced through

1) reduced cost of services,

2) provision of computerized therapy in settings outside the therapist’s office (home, school, or work), and

3) provision of alternative therapies that might reach individuals who do not seek treatment through ordinary channels.

It has been noted that some patients may find it more acceptable to work with a computer (or a computer assisted treatment program that combines computerized therapy with visits to a clinician) than engage in traditional clinician-administered.

The rationale for computer-assisted therapy also draws on the unique features of computers that could prove to be advantageous in treating psychiatric disorders. Potential strengths of computer-assisted therapy programs are listed below. One possible asset of computer programs may be an ability to engage patients in the treatment process. The predictions of traditional therapists that patients will refuse computer-assisted treatment or have a negative response to being referred to a “machine” have not been borne out by actual experiences. Patients typically enjoy working on computers and report that the experience is beneficial.  Newer programs have used features such as multimedia, virtual reality, interactive voice response, and portable palmtop computers to create stimulating and engaging therapeutic experiences.

Although some of the early investigations of computerized therapy focused on programs designed to substitute for clinician administered treatment, most contemporary research has been directed at finding ways in which computers can assist therapists or enhance the therapy process.  Instead of pitting machine against human therapist, these investigators have suggested that clinicians can learn to incorporate computer tools into their practices to improve the overall therapy experience.

So, computer-assisted therapy may offer a solution of providing cost-effective psychological services to individuals experiencing barriers to treatment. Although in computer-assisted psychotherapy a human touch is missing, computers have significant strengths that can be used to advantage in depression treatment:

• earlier access to treatment,


• more treatment time than clinicians can usually give,


• ease of treatment scheduling at home,


• lower treatment cost,


• confidentiality is greater and stigma avoided,


• consistency of treatment instructions is greater,


• self-help enhances a sense of control over one’s own destiny,


• built-in outcome measures and systematic feedback.

Clinical applications

Although currently available, CAT programs have been effective in research studies; they have limitations in clinical practice. CAT programs do not perform full psychiatric assessments, make diagnoses, or develop comprehensive treatment plans; nor do they screen for and manage impulsivity or other potentially dangerous behavior, such as suicidality. And, of course, they cannot display the empathic concern, wisdom, flexibility, and creativity of human therapists. Thus, in clinical applications, CAT programs appear to be best suited as components of an overall treatment strategy that is prescribed and guided by a professional.

CAT is just beginning to take hold in psychiatric practice. Although a vigorous effort is under way to produce and test programs for psychiatric treatment, and the use of computers in society is steadily increasing, most clinicians are either unfamiliar with CAT or have not yet tried to use these programs to augment traditional therapy. The time may be near when clinicians who want to use technology in psychotherapy will have access to useful and effective programs that can enhance learning, make treatment more efficient, and bring a valuable new dimension to the psychotherapeutic process.

Therapists of the future may be able to conduct their daily work with a variety of empirically tested computer tools. These adjuncts could be completed before or after a session, either in waiting rooms or at home, or even in specially designed therapy suites that provide advanced technology (such as virtual reality and fully realized multimedia treatment programs). Further development of port­able devices that have better function­ality and connectivity, that offer more realistic and engaging programming, and that weave together the human and technological components of treatment could provide a myriad of opportunities for realizing the promise of the computer as a therapeutic “assistant.”

Sources and Additional Information:

http://www.finddepressiontreatment.com/depression-software.html

http://wiki.medpedia.com/Clinical:Computer-Assisted_Psychotherapy

http://jppr.psychiatryonline.org/cgi/reprint/6/4/315.pdf

http://bjp.rcpsych.org/cgi/content/full/191/6/471

http://www.sharpbrains.com/blog/2008/09/03/the-future-of-computerized-cognitive-therapy/