Psychiatric Bulletin (2000) 24: 331-332. doi: 10.1192/pb.24.9.331
© 2000 The Royal College of Psychiatrists
Psychiatric Bulletin (2000) 24: 331-332
© 2000 The Royal College of Psychiatrists
Psychotherapy by computer
A postal survey of responders to a teletext article
Candida Graham, Locum Consultant Psychiatrist and
Abigail Franses, Research Associate
Maudsley Hospital, London SE5 8AZ
Mark Kenwright, Nurse Therapist and
Isaac Marks, Professor of Experimental Psychotherapy
Institute of Psychiatry, London
 |
Abstract
|
|---|
AIMS AND METHOD
Computerised self-help psychotherapies are fast becoming part of
psychiatric practice. The aim of the study was to assess potential user
preferences for the delivery of self-help psychotherapy for
obsessive—compulsive disorder (OCD) and phobic anxiety disorders. A
postal survey was undertaken of enquirers responding to a teletext article on
self-help psychotherapies for OCD and agoraphobia. Subjects were asked their
preferences for the delivery of self-help services for anxiety disorders,
their acceptance or refusal of general practitioner (GP) referrals for such
therapy, and how much they would be willing to pay for such a service.
RESULTS
Of 326 questionnaires sent out 113 completed questionnaires were returned
(35%). Twenty-seven per cent of respondents did not wish to access such
services via their GP, 91% wanted access via a computer system and respondents
were willing to pay an average of £10 per computer session (range
0-100).
CLINICAL IMPLICATIONS
Computerised self-help psychotherapies for OCD, phobic anxiety disorders
and depression are becoming part of everyday clinical practice. This may be
the first survey directly asking potential users about their preferred access
to self-help psychotherapies for anxiety disorders. A significant proportion
of responders did not wish to go via their GP to receive therapy and the vast
majority welcomed therapy delivered by some form of computer system.
|
|
Introduction
|
|---|
Computerised delivery of cognitive-behavioural therapy for psychiatric
disorders is developing rapidly. Self-treatment computer systems vary greatly
in the degree to which they take on the therapeutic role, decreasing the need
for clinician input (Oakley-Browne &
Toole, 1994). At one end of the spectrum are basic aids to
therapy, to be used by the clinician and patient to aid exposure in phobic
anxiety, for example, computer videoclips of spiders, virtual reality
depictions of heights, etc. (Hassan,
1992). A few systems are closer to becoming complete self-help
systems carrying out most of the therapeutic tasks involved in treatment,
decreasing the need for clinician input by 80-95%. Such computer systems help
service users to detail their problems, draw up a day-to-day treatment plan
specific to their needs, rate their progress, practise coping with setbacks,
do relapse prevention and recruit relatives as co-therapists if needed. Such
systems (e.g. BTSTEPS, COPE, FEAR-FIGHTER, Beating the Blues, Feelbetter) need
only initial screening of the service user by a clinician and an introduction
on how to use the system. A number of computer treatment systems are in
clinical service at the Maudsley Hospital, London, for example, BTSTEPS
(Marks et al, 1998) for the treatment of obsessive-compulsive disorder and FEARFIGHTER
(Shaw et al, 1999)
for the treatment of phobic anxiety disorders. Others, such as Beating the
Blues (Proudfoot, 1999), COPE
(Osgood-Hynes et al,
1998) and Feelbetter (Clarke,
1999) for the treatment of depression, are undergoing randomised
controlled trials. At present there are three main modes of delivery of
computer-aided care: internet access (Feelbetter), telephone-accessed
interactive voice response systems (COPE and BTSTEPS) and free-standing
computers (FEARFIGHTER and Beating the Blues). Users feel that computer
responses are empathic and understanding
(Weizenbaum, 1976;
Ghosh et al, 1988) and
that non-human instructions can be as therapeutic as human ones
(Ghosh et al, 1988;
Selmi et al, 1990;
Schneider et al,
1995). To date, however, no survey has been undertaken to look at
potential service users' preferred method of delivery of computer-aided
therapy.
|
|
The study
|
|---|
A small article was placed on the BBC teletext community pages to advertise
the Maudsley Hospital's computer-aided self-help services for
obsessive-compulsive disorder and agoraphobia. Information on the service and
a survey questionnaire were sent out to 326 enquirers who disclosed their
address. The questionnaire assessed how potential service users would want to
access self-help psychotherapy for obsessive-compulsive disorder and phobic
anxiety disorders. A simple tick box questionnaire was devised asking service
users:
- whether they would access self-help therapy if they had to have a general
practitioner (GP) referral;
- whether they wanted access to therapy via the internet, a telephone
interactive voice recognition (IVR) system, CD-ROM on their home computer, a
computer in their GP's surgery, a computer in a community mental health
resource centre, a computer in a leisure
centre/café/pharmacy, a book or another mode
of access;
- how much they would be willing to pay for each computer therapy
session.
|
|
Findings
|
|---|
One hundred and thirteen (35%) completed questionnaires were returned.
Twenty-seven per cent of respondents did not want to go via their GPs to
receive treatment for their anxiety disorder, and the majority of these
respondents (63%) gave the reason that this process was
‘bothersome’. Thirty-four per cent wanted to access therapy via
the internet, 56% via a telephone IVR system, 43% via CD-ROM on their home
computer, 23% via a computer at their GP's surgery, 22% via a computer at
their local community mental health resource centre, 16% via a computer in a
leisure centre, café or pharmacy and 62% via a
book (see Table 1). Other
methods of service delivery requested were: telephone support from a human
therapist (2%); audiotape or CD (3%); video (2%); group therapy (1%);
face-to-face therapy (3%) and interactive television (1%). Only 9% of
respondents did not want to access self-help therapy via a computer system.
For therapy accessed via a computer, participants were willing to pay a mean
of £10 per computer session (range 0-100).
|
|
Discussion
|
|---|
The response rate of the study (35%) while low, is average for postal
surveys (Parten, 1950;
Kerlinger, 1973), but does mean
conclusions need to be drawn cautiously. The fact that in the initial teletext
article computerised self-help services were outlined means that the study's
findings may be skewed towards computer-literate respondents. However, while
the majority of respondents (62%) wanted access to self-help therapy by the
traditional method of a book, these same respondents wanted access via some
form of computer system (91%). The authors believe this to be the first survey
to ask potential users about their preferences for the delivery of self-help
psychotherapies. The survey's findings have important implications for the
future delivery of psychotherapy services. At present the demand for
psychological therapies exceeds availability and computerised therapy has the
potential to meet this need, saving on therapist time by 80-95%. The survey's
findings indicate that a significant proportion of potential users do not wish
to go via their GP to access such therapy (27%) and the great majority want to
access self-help therapy via a computer system (91%), more specifically a
system which can be accessed from home (82%) (the internet, telephone IVR
system and CD-ROM on their home computer). These findings must be kept in mind
in the future development of computerised psychotherapies.
|
|
References
|
|---|
CLARKE, G. (1999) Feelbetter.
Parkland, OR: Kaiser Permanente Center for Health Research.
GHOSH, A., MARKS, I. M. & CARR, A. C. (1988)
Therapist contact and outcome of self-exposure treatment for phobias: a
controlled study. British Journal of Psychiatry,
152,
234-238.[Abstract/Free Full Text]
HASSAN, A. A. M. (1992) Comparison of
Computer-Based Symbolic Modelling and Conventional Methods in Treatment of
Spider Phobia. Doctoral Dissertation. Leeds: University of
Leeds.
KERLINGER, F. (1973) Foundations of
Behavioural Research. New York, NY: Holt, Rinehart &
Winston.
MARKS, I. M., BAER, L., GREIST, J. H., et al
(1998) Home self-assessment of obsessive—compulsive
disorder: use of a manual and a computer-conducted telephone interview: two
UK-US studies. British Journal of Psychiatry,
172,
406-412.[Abstract/Free Full Text]
OAKLEY-BROWNE, M. A. & TOOLE, S. (1994)
Computerised self-care programs for depression and anxiety disorders. In
Computers in Mental Health (eds G. Andrews et
al), pp. 96-102. Geneva: World Health
Organization & Churchill Livingstone.
OSGOOD-HYNES, D., GREIST, J., MARKS, I, et al
(1998) Self-administered psychotherapy for depression using a
telephone-accessed computer system plus booklets: an open US-UK study.
Journal of Clinical Psychiatry,
59,
358-365.[Medline]
PARTEN, M. (1950) Surveys, Polls, and
Samples: Practical Procedures. New York, NY: Harper &
Row.
PROUDFOOT, J. (1999) Beating the
Blues. London: Institute of Psychiatry.
SELMI, P. M., KLEIN, M. H., GREIST, J. H., et al
(1990) Computer-administered CBT for depression.
American Journal of Psychiatry,
147, 51-56.[Abstract/Free Full Text]
SCHNEIDER, S. J., SCHARTZ, M. D. & FAST, J. (1995)
Computerised, telephone-based health promotion: Smoking cessation program.
Computers in Human Behaviour,
11,
135-148.[CrossRef]
SHAW, S., MARKS, I. M. & TOOLE, S. (1999) Lessons
from pilot tests of computer self-help for agoraphobia/claustrophobia and
panic. MD Computing, 16,
44-48.
WEIZENBAUM, J. (1976) Computer Power and
Human Reason. San Francisco, CA: W. H. Freeman.
Top
Abstract
Introduction
