Monitor on Psychology - January 2012 - (Page 49)
Internet studies, which typically have attrition rates of 35 percent to 90 percent, but also lower than the 25 percent to 50 percent attrition rate seen in face-to-face psychotherapy. Now Mohr is seeking ways to provide that supplemental social support even more cost-effectively. One idea is to harness the power of online social networks to increase people’s adherence to Internet interventions by engineering in principles of what Mohr calls “supportive accountability.” Say a person is supposed to log in to the intervention a certain number of times. “If a patient’s network of peers can see a patients’s goals and their log-in activity and the patient values his or her peers, the patient will be more likely to meet his or her log-in goals,” says Mohr. In another line of research, Mohr and psychologist Albert “Skip” Rizzo, PhD, of the University of Southern California are exploring ways of creating computerized versions of interpersonal interactions once thought to require the presence of a live therapist. They are developing programmable virtual humans with whom users can role-play interpersonal skills. Existing solely online, these “online instantiations of humans” could play the role of a therapist who helps users practice assertiveness or other interpersonal skills in the safety of a virtual environment, Mohr explains. Mohr is also looking at how to make sure each individual gets the right treatment. “The effects are reasonable for Internet treatment, but probably not as strong as face-to-face therapy,” he says. “While we got large results in our trial, it was an initial field trial, and those typically have larger effects.” A 2009 meta-analysis of Internet interventions published in Cognitive Behaviour Therapy showed smaller result sizes, he points out. As a result, Mohr says, psychologists might use Internetbased interventions for clients who respond to them and save more intensive and costly face-to-face or over-the-phone psychotherapy for those who do not. Some people may not need the minimal contact such interventions involve but can instead help themselves, says T. Mark Harwood, PhD, a private practitioner in West Chicago and co-author of “Self-Help in Mental Health: A Critical Review” (2010, Springer). Self-help includes books, 12-step programs, online support groups, Internet-based programs and the like. While these approaches can be part of or even the main focus of therapy, they can also be used on their own by people whose problems aren’t severe. (Self-help isn’t for everyone, Harwood emphasizes, which is why he recommends that would-be self-help users seek an evaluation from a therapist first to make sure they’re good candidates for a primarily solo self-help approach.) Of course, there are some approaches with no empirical support behind them, either because the evidence doesn’t support them or because they simply haven’t been studied yet. But, Harwood says, there is ample evidence indicating that some self-help approaches can be as effective as therapy itself. He cites as an example a 2008 study in Acta Psychiatrica Scandinavica that found that a self-help approach called
J a n u a ry 2 0 1 2 • M o n i t o r o n p s y c h o l o g y
cognitive self-therapy was not only as effective as therapistadministered treatment but much more cost-effective. Still, there’s some resistance to self-help approaches among psychologists, says Harwood. He doesn’t think that should be the case. After all, he says, in addition to helping individuals working on their own, self-help can demystify and destigmatize psychological interventions. That may make working with an expert more palatable should the need arise in the future, he says. One organization that’s already embracing alternatives to traditional psychotherapy is the Department of Veterans Affairs. Faced with a flood of service men and women returning from Iraq and Afghanistan — an estimated one third or more with mental health problems — the nation’s largest health-care system is using all sorts of innovative strategies for getting evidence-based treatment to veterans. These include assessment and treatment via videoconferencing, self-help via smartphone technology and the use of lay people like fellow veterans to deliver care. Such options allow access to care to patients who live too far away from VA facilities and give veterans a choice about how to access care, says Associate Director Denise M. Sloan, PhD, of the Behavioral Science Division at the National Center for PTSD at the VA Boston Healthcare System. These alternative options can help patients overcome concerns about confidentiality and the stigma associated with seeking help that are prevalent in the military culture. And these strategies have the potential to deliver services to large numbers of people quickly and efficiently. “The more options, the more people you can reach,” says Sloan.
Kazdin shares his vision
Click here to watch a video of Dr. Alan Kazdin discussing his take on how psychologists need to retool their research, education and training to reach those in need. Click here for a transcript of the video.
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