The good news is: they are not outsourcing your job to Bengalore.
The bad news is: they are replacing you with an app.
If you are a psychotherapist-- especially one who practices cognitive-behavioral therapy (CBT)--that’s today’s news.
For those therapists who do not practice CBT, the news is not much better. The more studies there are, the more we see that CBT does the best at helping people with a variety of psychological conditions.
And yet, researchers have discovered that the same treatment can be provided by an app. It’s called online CBT. You can download it onto your iPad and work away at reprogramming your mind and mitigating the influence of those pesky negative and self-destructive thoughts.
As a consolation for therapists, studies show that it helps for a patient to check in on occasion with a coach. And they also show that for really difficult cases, a human therapist is preferable to an app.
That leaves a large number of people out there with only their app to guide them.
Tina Rosenberg reported the story in the New York Times.
First, she defines CBT:
… a cognitive behavioral therapist aims to give patients the skills to manage their moods by helping them identify unhelpful thoughts like “I’m worthless,” “I’ll always fail” or “people will always let me down.” Patients learn to analyze them and replace them with constructive thoughts that are more accurate or precise. For example, a patient could replace “I fail at everything” with “I succeed at things when I’m motivated and I try hard.” That new thought in turn changes feelings and behaviors.
As I have often had occasion to point out, this form of therapy has produced excellent clinical results. The new studies have shown that online CBT works just as well in most cases.
The success of cognitive behavioral therapy is well known; many people consider it the most effective therapy for depression. What is not widely known, at least in the United States, is that you don’t need a therapist to do it. Scores of studies have found that online C.B.T. works as well as conventional face-to-face cognitive behavioral therapy – as long a there is occasional human support or coaching. “For common mental disorders like anxiety and depression, there is no evidence Internet-based treatment is less effective than face-to-face therapy,” said Pim Cuijpers, professor of clinical psychology at the Vrije Universiteit Amsterdam and a leading researcher on computer C.B.T.
Of course, the app is especially helpful for people who do not have access to a real therapist, for reasons that have to do with time or money or location:
Depression is the leading cause of disability for women worldwide, and the second-leading cause for men. If medical care is hard to come by in much of the world — in rural Indiana as well as rural India — mental health care is often impossible to get. In the United States, at least half of major depression goes untreated, and in very poor countries the figure is close to 100 percent.
Online therapy can’t do much about those barriers. But it can help people who stay sick because there are no therapists nearby, who fear being judged or embarrassed in therapy, who can’t take time off from work, or for whom the cost of treatment is too high. It allows people to carry therapy around in their pockets, use it at 2 a.m., and pay nothing or nearly nothing.
How effective is it?
A Swedish survey of studies found that online C.B.T. has been tested for 25 different ones. It was most effective for depression, anxiety disorders, severe health anxiety, irritable bowel syndrome, female sexual dysfunction, eating disorders, cannabis use and pathological gambling. “Comparison to conventional C.B.T. showed that [online] C.B.T. produces equivalent effects,” the researchers concluded.
Obviously, there are limits:
Cuijpers said there were fewer studies of online therapy to treat insomnia, pain and alcohol abuse, but what’s been done has shown good effects. (Last week the Upshot published one contributor’s story of his success using online C.B.T. for insomnia.)
Though, in some cases, human support or coaching is necessary:
One study of adolescents found that almost 60 percent of users stopped MoodGYM after the first module when they were working unsupported on their own. When the same program was used with monitoring and support, only 10 percent stopped.
Obviously, therapists see it as a threat to their practices:
The reception for online cognitive behavioral therapy isn’t uniformly warm — and the dissenters are not just therapists worried about being put out of business (if only untreated depression were that scarce a commodity). One big issue is that someone seriously ill might waste time tootling around with an online program, not realizing he needs more help. Or he might use a program that isn’t right for him. It’s safer, of course, if a therapist sees the patient and then prescribes online therapy. That’s an efficient use of therapists — but it still requires a therapist, and that negates some of online C.B.T.’s advantages.