The Computerized Psychotherapist Will See You Now

Could psychotherapy be mostly computerized someday? A recent article in The Atlantic, "The Extremely Personal Computer: The Digital Future of Mental Health," extrapolates from current trends to show how this could come about by combining novel computer-assisted self-management techniques with mobile phone apps that monitor a patient's vital signs. Social media elements are also included in the mix.

The first iterations of the trend toward using software in therapy, the article notes, come from companies such as Posit Science, Dakim, Lumosity, Brain Plasticity, SharpBrains, and MoodGym.

Some of these companies feature "brain training" applications intended to make people smarter, increase alertness, and/or stave off cognitive decline in the elderly.

For example, Dakim claims that its BrainFitness app can prevent or slow the progression of Alzheimer's disease. Though no specific proof is offered, the firm cites studies showing the positive effects of cognitive stimulation in delaying memory decline related to dementia.

[ Which mobile medical apps are doctors and patients turning to most? See 9 Mobile Health Apps Worth A Closer Look. ]

Lumosity, the largest player in the brain training field with 20 million subscribers, lists some peer-reviewed papers on its website to support its claims of "improving brain health and performance."

MoodGym sells multimedia programs that teach cognitive behavior training skills for preventing and coping with depression and anxiety disorders.

The new behavior health applications also address a number of other conditions. Posit Science, for example, says that its Brain HQ app has helped cancer survivors deal with memory loss and other cognitive problems, depression, and anxiety. And Brain Plasticity, a San Francisco-based research institute and "technology incubator," has received a $2 million grant from the Department of Defense to study the effects of using Brain HQ with patients who have traumatic brain injuries (TBI).

Brain Plasticity's research extends to many other areas as well. For example, the National Institutes of Health (NIH) gave the firm a $3.65 million grant to develop cognitive remediation software for schizophrenic patients. Last June, Brain Plasticity announced it was launching a multi-center trial to test the effects of a "computerized, brain-plasticity-based program" for this purpose.

The institute is also investigating the use of this kind of software for Alzheimer's and Parkinson's prevention and to treat ADHD in children, TBI, social cognition deficits, anxiety disorders, and major depression.

Wellness and health promotion companies have also developed apps for improving behavioral health. For example, Johnson & Johnson's Wellness & Prevention subsidiary offers a computerized self-help program for depression. According to the firm, "HealthMedia CARE for Depression emulates a behavioral health coaching session, without the coach, to deliver an individually personalized depression management plan."

Don Hilty, MD, professor of psychiatry and behavioral sciences at the University of California Davis School of Medicine, told InformationWeek Healthcare that all of these new techniques and applications could be a useful adjunct to psychotherapy. "It probably won't replace the therapist," he said. "But in areas where the therapy is direction-based or cookbook, a lot of that could be done on the computer, and a lot of screening can be done on the computer."

Hilty, a member of the scientific program committee of the American Psychiatric Association, said that despite the paucity of peer-reviewed papers in this field, brain training, bio-feedback, and computerized therapy programs could help people improve their mental health and perhaps prevent cognitive decline.

Brain teasers and other mental games, he said, are great for young people because "it's something they enjoy, and it will stimulate them to think. And with older adults, whatever we can do to keep them stimulated is going to be very good, maybe not in preventing Alzheimer's, but in delaying the onset."

As for computer programs to arrest cognitive decline in patients with TBI, Hilty said there's some scientific support for this approach. "Neuro-psychologists do exercises in which we emphasize someone's cognitive strengths and/or build permanent detours around areas that can't be fixed. And there's no reason that computers can't do at least half that work."

In addition, he said, some apps could help patients take better care of themselves by providing instant feedback based on continuous screening and assessment of their symptoms. This data could generate a flow chart, as the Atlantic article points out, to show their progress and where they need to do more work. "That would empower the individual and they could seek consultation as necessary," Hilty said.

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