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Computers get a boost as psychotherapists.

Computers get a boost as psychotherapists

Psychotherapy may be going from the couch to the computer. In a pilot study reported in the January AMERICAN JOURNAL OF PSYCHIATRY, investigators found that a computer programmed to use specific psychological techniques is as effective in relieving mild to moderate depression as a human therapist using the same approach.

The results do not suggest flesh-and-blood therapists are irrelevant in treating depression, but "there's definitely a place for computers in the mental health field," says study director Paulette M. Selmi, a psychologist with a private practice in Mesa, Ariz.

Selmi devised a computer treatment program that operates on the tenets of cognitive-behavioral therapy, which stresses practical exercises to change thoughts and behaviors contributing to depression. Numerous studies have documented the effectiveness of cognitive-behavioral treatment when administered by a trained therapist. The computer program did not interpret what people divulged about their lives or carry on a dialogue with them, Selmi notes. It simply incorporated their answers to open-ended and multiple-choice questions into recommendtions for overcoming self-defeating attitudes and actions.

Selmi and her colleagues randomly assigned each of 36 volunteers, all reporting symptoms of mild or moderate depression, to one of the following: computer treatment, sessions with a therapist, or a waiting-list control group. The first two groups attended six weekly therapy sessions. For those undergoing computer treatment, an experimenter helped start and stop each session and answered any questions that arose, most of which concerned computer procedures.

Two months after the therapy sessions ended, eight people in the computer group and nine people in the therapist group reported a significant mood improvement, compared with one person on the waiting list.

The human therapist -- psychologist Steven P. Sorrell of the University of Wisconsin-Madison -- modeled his technique on the capabilities of the computer program, which somewht limited his flexibility during therapy sessions, Selmi points out. Furthermore, a typical course of cognitive-behavioral therapy would involve about 20 sessions.

But the success of any form of therapy often relies on factors other than technique, such as the patient-therapist relationship. In the computer group, the novelty of the method may have influenced patient improvement, Selmi notes. The computer also served as an electronic journal in which patients wrote down their thoughts and reviewed them; many volunteers cited this as an advantage of computer therapy, she says.

"Some people related to the computer as if it were a person," Selmi adds. For instance, at the end of the first session, five computer-treated patients said they perceived "therapist understanding."

Although the study must be extended to depressed people treated at mental health clinics, "this is exciting work," says psychiatrist Aaron T. Beck of the University of Pennsylvania in Philadelphia, who originated cognitive therapy in the 1960s. Further development of Selmi's computer program may help ease the shortage of cognitive therapists and reduce the costs of therapy, Beck asserts. Therapists could then concentrate on more severe cases of depression, consigning milder cases to the computer.

Selmi, however, contends computers probably will work best when combined with traditional cognitive therapy. They are especially well suited to handle the educational techniques of such therapy, she maintains.

"Even though I developed this computer program, I guess I'm just a conservative clinician," Selmi says. "I don't think computers should replace human therapists."
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Author:Bower, B.
Publication:Science News
Date:Jan 20, 1990
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