Psychology Software Takes Over From British Therapists

LONDON – For nearly her entire life, Mary had a crippling fear of cramped spaces that meant she couldn't travel on airplanes, subways, or cars.

Seeing a psychologist didn't help. So she tried something else.

The 61-year-old bookkeeper, who only gave her first name to protect her privacy, sat down in front of a computer and spilled out her problems to a kind of psychiatric computer game called "Fearfighter."

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Last year, Fearfighter was one of two programs endorsed by Britain's health advisory watchdog for people with panic attacks, mild depression, or phobias.

People uncomfortable with getting advice from a computer can still choose to see therapists, but the option of logging on for help is now available — and will be paid for by the government-run National Health Service.

In Britain, patients registered with the NHS routinely wait up to six months to see a psychiatrist; nearly 90 percent of people with mild depression never actually see a therapist.

The computer programs now mean that for some patients, getting psychiatric counseling is as easy as getting a password from their general practitioner to access the program online.

"Six months for some patients might be too long," said Dr. Paul Grime, an occupational medicine expert at London's Royal Free Hospital.

Since the endorsement was made last February, many British psychiatric patients have skipped the weekly sessions at their doctor's office.

Instead, they now log on at home, or go to libraries to use computers designated to run the programs, where there is a health professional ready to help if necessary.

The computers are not authorized to prescribe medicine. A qualified human is required for that.

The computerized treatment is possible because people with phobias, from fear of spiders to fear of heights, tend to get the same basic therapy.

"The idea is that the repetitive parts of the therapy are done by a computer, which can then make decisions based on these answers," said Dr. Isaac Marks, a professor emeritus at King's College Institute of Psychiatry in London, and co-developer of "Fearfighter."

Treating short-term problems like phobias or mild depression often simply means teaching patients new ways to think or react — something a computer can be programmed to do, Marks said.

In Britain, a few thousand people are estimated to have already been treated with the programs.

Judy Leibowitz, a clinical psychologist who runs mental health programs in London, said the anonymity of computer therapy was a selling point for certain patients.

"There are lots of people who are not that keen on pouring out their heart to a therapist," she said.

Still, psychiatrists shouldn't worry that they might become obsolete.

"We still need therapists to be creative and do all the things a computer can't, like express empathy and respond to the idiosyncrasies of a person's life situation and their history," said Dr. Jesse Wright, a psychiatrist at the University of Louisville, who has studied the use of computer therapy.

Serious psychiatric problems like bipolar disorder, suicidal tendencies or schizophrenia are too complex to be cured by computer programs.

Britain decided to roll out the anti-panic and depression computer programs nationwide after a group of experts sifted through evidence and concluded that the programs work just as well as face-to-face psychiatric care.

"We wanted to be confident that this wasn't just a second-best option," said Dr. Steven Pillings, of University College London, who led the British committee that made the recommendations.

Many experiments in Britain, the United States and elsewhere showed that patients counseled by computers made just as much progress as those counseled by real, live therapists.

Using computers to treat patients was also much cheaper and could help cash-strapped health systems expand care.

One study estimated that therapists using computer programs could double the number of their patients.

In "Fearfighter," patients are taught to recognize the signs that trigger their panic attacks in the hopes of preventing one. But if that doesn't work, they're also instructed on how to cope with their fears.

The program asks patients to identify the personal triggers that set off their panic attacks. They're told to be more observant of these red flags, and to keep a diary of things they avoid because it makes them nervous.

Then, the computer gives them homework: They must seek out uncomfortable situations to practice their new skills.

In the anti-depression program, patients watch staged vignettes in the lives of depressed people, using professional actors.

For example, in a scene where a character has an argument with a spouse, patients are shown how the person thinks through different ways of responding.

It is then up to the patients to decide how the character will react, in a process that psychiatrists say helps them develop new thinking patterns.

The computer programs take roughly 10 weeks of hourly sessions, including scheduled telephone calls from a health worker to check on progress.

For Mary, computer therapy seems to have worked. Before using Fearfighter, she had been too afraid to fly or ride the subway.

But after eight weeks, Mary told program developers that she had ridden the subway without even a twinge of anxiety. The computer treatment, she said, was far more effective than talking to a psychologist.

"I am very puzzled how this could have happened so quickly," she said.