Can a Computer Replace a Therapist?

It’s an intriguing question, and one that entrepreneurs and researchers continually look at as progress is made with artificial intelligence and the increasing accessibility of the Internet — can an online computer program be used as effectively with a family doctor as with a psychologist?

The fact is, most people with a mental health disorder don’t usually seek out a mental health professional at first. Instead, they contact their family physician or general practitioner (GP). The problem is that while GPs are really good at narrowing down what a problem is likely to be and treating most common and non life-threatening medical concerns, they are not mental health experts. So their ability is somewhat limited when it comes to ongoing treatment of such a concern — they can prescribe an antidepressant and listen to your complaints for 5 or 10 minutes, but after that, you’re on your own.

Most GPs recognize this limitation and make the appropriate referral to a psychiatrist or psychologist or the like for followup.

But some researchers in Australia wondered whether a self-help computer program coupled with seeing a GP could compete with the same program being used with a psychologist. The participants in the study suffered from panic disorder (with many also suffering from agoraphobia).

Except that the researchers, for reasons unclear, stacked the deck at the onset of the study. They allowed the group of people seeing the GP to see the GP face-to-face over the course of the treatment. Instead of allowing the same for the psychologists, they limited contact to the psychologists by email only.

The other confound in this particular study was that the same psychologists that were used to treat patients were also used to assess the amount of panic in participants in both the psychologist-treatment group and the GP-treatment group. That’s a general no-no in research.

The results were not surprising:

In this study, Panic Online [the online treatment computer program] (whether supported by eTherapists or face-to-face GPs) led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity, agoraphobia avoidance, and quality of life. Improvements were maintained at follow-up[…]

I say “not surprising” because as usual with research that has no control group, you’re only showing what hundreds of other studies have shown — that any type of treatment is usually better than no treatment at all. The individual attention given to a person by another human being (and other nonspecific factors) have a huge therapeutic effect in and of themselves. If you had them sitting in front of a computer reading about panic disorder (or heck, reading a book about panic disorder), it may have provided for the same positive effects as long as the person also communicated with a GP or psychologist on a regular basis.

For both groups, only half the participants were panic-free at the end of treatment. Meaning that, as with many treatments available today, this treatment regimen is only somewhat effective. Half the people trying it will still have panic attacks at the end of treatment.

Significantly, more people dropped out of treatment in the GP group than in the virtual psychologist group. That suggests that even a virtual psychologist trumps a real life general practitioner, probably because the psychologist has far more extensive training in the cognitive behavioral techniques used and emphasized in this treatment program… And perhaps because the psychologist got into the field to help people with these kinds of problems, while that is not generally the case with most GPs.

What this study clearly illustrates is that yes, you could get away with people only seeing a GP and using some sort of online program as a supplement, but that you still won’t get comparable treatment outcomes than if you used that program with a trained mental health professional. The answer from this research suggest not in burdening GPs with additional treatment efforts when they are already strained for time and energy, but to instead encourage people to seek out alternative treatment modalities that best fit with their lifestyle (e.g., online therapy, for one).

Reference:

Shandley K, Austin DW, Klein B, Pier C, Schattner P, Pierce D, Wade V. (2008). Therapist-assisted, Internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists?. J Med Internet Research, 19;10(2):e14.