BY NADIA MICALI - Dept. of Psychological Medicine, Institute of Psychiatry - De Crespigny Park - London
The psychiatrist and computers: a happy marriage?
Luckily or not computers have become an integral part of our professional life in the last decades. Either loved or hated our PCs are our invaluable companions. Even psychiatrists, not keen on machines taking over humans intellectual chores in principle, cant do without them, be it for a research database or to write patient correspondence.
But what about computer-mediated therapy?
We live in an age where use of electronic communication has become very common and accessible to everyone. Patients and health care providers use of e-mail is growing fast. A survey in the States in 1999 showed that almost 3,000 doctors of the 10,000 interviewed had written e-mails to their patients. Such a survey has not yet been done, to my knowledge, in the UK.
In terms of psychiatric treatment, there have been some reports of Internet-assisted therapy, mainly in the form of counselling, psychotherapy and family therapy. It seems that e-mail can be useful for patients to talk about embarrassing experiences and also be less intimidating than face-to-face contact with a therapist.
Some patients would surely benefit from the use of electronic communication in psychiatric practice. Often both patients and their carers report on having acquired information on a certain illness or drug therapy on the Internet, showing a greater computer literacy than we have.
In the UK, similarly to the U.S., Internet based self-help groups are mushrooming, the help offered goes from addictions to autism; these groups have been evaluated with positive results in the U.S.
E-mail can be used as a clinical adjunct in psychiatric treatment. This is particularly valuable in some disorders, i.e. eating disorders or anxiety disorders. It offers the possibility of communicating by writing on a computer rather than facing somebody, which can be very difficult for some patients who often find talking to a therapist or clinician quite inhibiting. It also encourages patients not to be forced into the therapeutic relation, but to initiate contact with the therapist autonomously.
E-mail also allows the possibility of unscheduled contact and access to the clinician whenever suits the patient. Yager regularly employs e-mail as an adjunct in the treatment of eating disorders.
In the UK e-mail therapy is growing in popularity, as is its use in therapeutic settings.
Robinson utilised e-mails in a preliminary study on treatment of Bulimia Nervosa, with good results, Treasure in the treatment of patients with Anorexia nervosa.
Whilst waiting for studies confirming its value, clients views inform us on the acceptability of this therapeutic approach.
"The email was a source of great strength for the whole family. The simple task of writing one line to you each day was often the only thing I achieved. The rest of the spent staring at blank walls unable to read or do. Writing it down and pressing send made me feel as though I was sending some of the load away into the ether. It really helped. I think it was the first part of getting better", writes a patient.
CD-ROM guided treatments
In the last few years guided treatments on CD-ROMs have become quite popular. Some approaches are clearly more suitable for a computerised version than others.
CBT is one of the therapies that have been more widely incorporated into computerised treatments. There is some evidence that this kind of treatment is useful in the treatment of obesity, anxiety disorders, phobias, etc.
"Beating the blues" is an interactive computerised treatment, on CD-ROM, for the treatment of depression and anxiety disorders. It is based on CBT techniques and is divided into several modules and sessions with homework assignments etc. The treatment is offered in conjunction with clinical monitoring in GP and healthcare settings, with clear indications for treatment. Patients comments seem to be positive up to now.
A pilot study at the Maudsley Hospital is also investigating outcomes of a CD-ROM treatment for Bulimia Nervosa. This is also CBT based and is divided in modules with homework, food diaries, interactive sessions.
These are only two examples of CD-ROM treatments, surely many more are being developed or tested in the country.
In conclusion, the use of computers in mental health is growing rapidly in the UK, both as an aid for therapy or a means for delivering therapy. Its practical use will depend on its therapeutic efficacy, but also on its acceptability by clients (and psychiatrists).