Introduction

For many years, psychiatric researchers have examined the use of technology in facilitating and complementing psychiatric counseling and psychotherapy. Technology currently plays many different roles and performs many different functions in the treatment of psychological disorders: from computer-administered surveys and questionnaires to pain-controlling virtual reality devices to carbon-dioxide-measuring devices for anxiety treatment.

One method, researched at Pennsylvania State University, involves the use of personal digital assistants (PDAs) in treating social phobia. A computer program was created with diary-like functions to monitor anxiety, relaxation guidance, cognitive restructuring exercises, and self-control desensitization. The program had been designed to treat anxiety disorders and was extended to apply to social phobias. The PDAs proved to have a highly effective outcome. (Prezeworski)

Another study on computer and internet based psychotherapy interventions by the Department of Psychiatry at Stanford University has had similar conclusions, finding computer based assessment and treatment to be less costly and as effective as face-to-face treatment when applied to depression and anxiety disorders. It was also indicated that internet support groups may actually prove to be more effective and have advantages over face-to-face therapy. However, privacy presents an ethical concern for internet based activities; all internet records are required to follow federal privacy guidelines and thus confidentiality of records cannot be guaranteed. Still, computer based programs have been found to promote more honest reporting, freeing the users from embarrassment of revealing sensitive information, and allowing more efficient and accurate assessments in many cases. The use of PDAs in collecting such real-time data as moods, thoughts, and behaviors has proven useful in research but has not yet been implemented in clinical practices. (Taylor)

COPE, a self-help program developed for patients suffering from depression investigated the results of therapist-administered therapy and computer-administered therapy. Figure 1.1 shows the mean weekly Beck inventory scores of patients given computer-administered therapy, therapist-administered cognitive behavioral therapy, and no therapy (control group); n represents the number of patients studied. (Greist)

Figure 1.1

 

There is debate as to whether online therapy is actually viable because of the lack of visual and non-verbal cues seen in face-to-face interactions. However, “many people in crisis situations tend to share their experiences and feelings with anonymous, unseen partners on the Net, as personal inhibitions diminish…surfers in crisis and distress are drawn to such virtual places, frequently eager to share their painful experiences” (Fenichel).

Several other studies vouch for the effectiveness of using computers as a therapeutic tool. In a study done by researchers from the Stanford University School of Medicine and the Department of Psychology at the University of Queensland, it was found that when comparing computer-therapy alone to therapist directed therapy alone, computer therapy was just as or more effective. However, computer therapy was most effective when used in conjunction with therapist treatment. The major components of the computer-assisted treatment program used in the study are shown in Figure 1.2 (Newman).

 

Figure 1.2

The use of hand-held computers was also studied when used to treat anxiety patients as shown in Figure 1.3. (Newman)

 

Figure 1.3

Based on the previous research and proven effectiveness of self-help and computer-assisted therapy, R.I.S.E strives to extend and improve upon the application of PDAs in the treatment of individuals with depression and anxiety. The application adds a communication functionality that will allow users to directly contact their psychiatrist and other participants in their group therapy, in addition to psychotherapies and directed self-help, though administering self-help and recording mood are the two main focus functions of the interface. In addition, R.I.S.E increases the customizability of the program so that each individual can tailor the functions of the interface to suit their own personal needs and moods.

The program focuses on users suffering from acute depression and anxiety, conditions that have proven responsive to self-help techniques. Users would be able to utilize the interface independently, without seeking treatment, but we want to focus on those who are currently undergoing group therapy and/or treatment with a psychiatrist. It is geared towards, though not limited to users between the ages of 30 and 50, users that will most likely be working full-time and not have time for or access to other methods of self-help (books, tapes, etc.) during the day. These users would likely benefit from carrying a compact portable device to guide them and allow them to log their moods during any time of the day. Depression in users in this age group tends to result from set ways of thinking and behaving, as opposed to depression in young people, which tends to result from changes related to adolescence. The interface is also designed to help users who find face-to-face contact and personal interaction with psychiatrists and other patients intimidating. These patients can communicate through messaging on the PDA and answer questions and record their moods without having to answer potentially embarrassing questions from the psychiatrist or verbally express very personal emotions.

The users will be able to carry the device around throughout the day during work, at home, or running errands. It will serve as a source of information and instructions for regular self-treatment, practice of techniques, and communication with the doctor. The interface will also provide assistance and guidance in situations where a patient’s condition becomes acute (e.g., he or she has a panic attack or suffers a sudden feeling of severe depression). The user can quickly pull out their PDA to reference calming and breathing techniques, play soothing music, or read quotes or stories that they find comforting and helpful. At the end of the day, the user will record their general levels of anxiety or depression, log any significant events that caused changes in mood or any attacks that they may have had, and record subjective impressions about their condition and their relative amount of improvement. All of this information can then be shared with their psychiatrist and therapy group electronically or by bringing the PDA with them to sessions.

By providing a portable, electronic self-help reference and guide, our group hopes to increase the effectiveness of self-help techniques and applications, to encourage users to continue with and maintain treatment, to make guidance and help available to the patient at all times, and to allow patients a greater amount of control and participation in their treatment. The therapeutic uses of writing and literary arts have been previously investigated (Wright) and by providing a journal and record of moods and thoughts, we hope to utilize the therapeutic results of writing, as well as improve the evaluation of patients’ progress, improve communication between the doctor and patient, overcome apprehension of patients who feel embarrassed or timid about answering personal questions, and provide patients with a record of their treatment and experience.

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