ETherapy Flashcards
Depression Symptoms
- Lowered mood or loss of interest or pleasure in daily activities
- Weight change or change in appetite
- Change in sleep (insomnia or hypersomnia)
- Fatigue or loss of energy
- Feelings of guilt or worthlessness
- Impaired concentration skills
- Suicidal thoughts
- (bereavement exclusion as grief might even be protective)
Anxiety Symptoms
- Excessive, uncontrollable, and often
irrational worry. - Moderate correlation with depression.
- Can interfere with daily functioning: fatigue,
fidgeting, breathlessness, difficulty
concentrating, irritability, restlessness. - Includes phobias, social anxiety, panic
attacks, generalized anxiety disorder,
separation anxiety
Stress Symptoms
- Long-term state of reacting to complex environmental demands.
- Physical symptoms can include: low energy, insomnia, lowered immune system (frequent colds), upset stomach and headaches
- Long-term stress leads to burnout: state of exhaustion, characterized by feelings of disillusionment and helplessness. Loss of interest and motivation, irritability, feeling overwhelmed and resentful.
Acute Stress Disorder Symptoms
- In response to a traumatic event.
- Reduced emotional responsiveness,
awareness of surrounding, recurrent
images, thoughts, flashbacks, reliving the
experience. - Avoidance of stimuli associated with
trauma.
Barriers to seeking help
- Access problems (e.g. living in rural area)
- Perceived stigma to seeking help (especially for older people) Lack of available psychologists
- Long delays and waitlist- Cost
How effective is self-help?
- The answer is: “We don’t know”.
- Unknown starter and situation. (who created this?) + (Before and after the self help).
- Less than 50% of people finish a self help program
- Unless psychologists engage with eTherapy themselves more, there could be some apps around that cause more damage than do good.
What is eTherapy?
- Psychological therapy that clients complete
under the supervision and guidance of a psychologist. - The level of support and guidance can be very minimal (via emails, SMS, or phone call).
- Compared to face-to-face therapy (45-60 min per week),
psychologist’s time is reduced to around 5-20 min per week.
Computerised CBT (CCBT)
- Cognitive-Behavior Therapy (CBT)is a popular and effective therapeutic approach for treating depression and anxiety.
- Its structured approach to therapy and exercises makes it very suitable for use as eTherapy.
- Only mild cases should use computerised CBT (CCBT)– urgent cases (e.g. suicide danger) need to receive urgent face-to-face help.
“Beating the Blues” (Self-help program)
The program typically follows this structure:
- 15min introductory video then eight 1-hour sessions to promote helpful thinking styles.
- Clients complete weekly homework, and regular progress reports are given to facilitator and client.
- Other programs include: MoodGYM, Colour Your Life, Managing Your Mood, Overcoming Depression.
“Sparx” - Fantasy Game
- For adolescents experiencing mild to moderate depression.
- Uses a 3-D fantasy gaming environment to deliver Cognitive-Behavioral Therapy.
- User interacts with a character who provides psychoeducation, assesses mood, sets real-life challenges (e.g. homework tasks).
- User chooses a character to restore balance in the world infested by GNATs (gloomy, negative, automatic thoughts)
- Uses problem solving, relaxation, identify negative thinking, cognitive restructuring etc
“Sparx” - Lessions
Level 1 = Finding Hope (Cave Province)
>. p
“Sparx” - Lessions
Level 1 = Finding Hope (Cave Province)
>.Psychoeducation about depression (Gloomy Negative
Automatic Thoughts {GNAT}, Into Hope)
Level 2 = Being Active (Ice Province)
>. Activity scheduling and behavioural activation (Relaxation)
Level 3 = Dealing with Emotions (Volcano Province)
>. Interpersonal skills + dealing with strong emotions
Level 4 = Overcoming Problems (Mountain Province)
>. Problem solving skills
“Sparx” - Lessons: Part 2
Level 5 = Recognizing Unhelpful Thoughts (Swamp Province)
>. Cognitive restructuring (recognizing different GNAT)
Level 6 = Challenging Unhelpful Thoughts (Bridgeland Province)
>. Cognitive restructuring + Interpersonal skills
Level 7 = Bringing it all Together
>. Recap all of the skills + Mindfulness + Relapse prevention
“Serious Games”
- “…the use of digital gaming technology to
address a specific set of learning
objectives or behavioral goals” (Schuller et
al., 2013, p.48). - Apart from use with autism, it is not so
much used for serious psychological
problems, but more for psychoeducation. - Example is www.maseltov.eu to promote
integration and cultural diversity:
Is eTherapy working? Part 1
- Many reviews have confirmed that eTherapy is just as effective as “treatment as usual”, which means a lot of money can be saved by using eTherapy.
- However, there are some methodological difficulties when testing the effectiveness of eTherapy (e.g., what is an appropriate control group?).
Is eTherapy working? Part 2
.- So, the conclusion is that eTherapy appears to be as effective as other types of therapy. - More effective for depression, anxiety, eating disorders, cannabis use, gambling, and a little less for chronic pain or fatigue.- But booster sessions may be required.
Level of support
- eTherapy is more effective if there is higher
level of support for patients. - A certain minimum level of support is necessary to keep patients engaged and motivated to finish the homework tasks.
- There is some concern that meaningful relationships between patient and therapist cannot be established online, but this may not be such a problem (at least for therapies for
mild psychological problems).
Do patients like eTherapy?
> . Only about 40% of patients use eTherapywhen offered, and then, only around 50% of people finish eTherapy.
. More people finish eTherapy if they receive guidance and support from a therapist. But once people have started, they tend to like eTherapy.
. The most common reasons for discontinuing eTherapy are: lack of time, too demanding, preferring face-to-face contact.
eTherapy: Current challenges
- Technical issues (e.g. battery life, Internet
access) - Privacy concerns
- Ethical issues (location of service and liability insurance)
- Making eTherapy attractive for more people
- Is it better as an add-on to therapy? In other words, to support face-to-face therapy?
Examples of powerful add-ons
Assistance with life skills:
- Giving prompts to people with autism for social
situations.
- Or help with name and face recognition for people with
prosopagnosia or dementia.
The future: Advantages of eTherapy: Part 1
- Our lifestyles are changing with technology. Therapy needs to change with it
- Being a psychologist is sometimes likened to being a coach: You teach your client skills, but they have to apply it themselves.
- But unlike a sports coach, the psychologist is usually not there when the client needs to deal with the problems.
The future: Advantages of eTherapy: Part 2
- Using eTherapy means any data we are collecting are likely to be more accurate.
- For example, patients often complete diaries and homework last minute and not when they are supposed to. Now the psychologist can find out!
- Speech pattern recognition
- Intelligent reminding
- More multidisciplinary therapy (e.g. combined with physical exercise, nutrition intervention)
- Robots
Online MBIs
• Spijkerman et al. (2016) reviewed 15 online MBIs
(8 MBSR, 2 MBCT, 5 ACT)
• Delivered usually through a website
• Varying degrees of guidance was provided (e.g.
individual email coaching or online message
boards)
• Small but significant effect size for anxiety,
depression, and stress
• Thus, lower effect size than traditional MBIs
• High drop-off rate noted
Beck’s Depression Inventory II
21 items where each item presents four
statements from which the respondent needs to
select one option
• The four statements are scored 0, 1, 2, or 3
• A higher score reflects greater degree of
depression
Robots and Health
• Robots are no longer limited to science
fiction but are now increasingly starting to
find a role in the provision of healthcare
• For example, Paro or KiliRo:
