Computer-Supervised Exposure Treatment for Phobias

Abstract

Twenty phobic outpatients were treated by 9 weekly "interviews" at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75-80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-up in both groups.

A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety

“…[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] Of these, 11 were RCTs and five were non-RCTs, including two cohort studies, two pilot studies and one comparative study. The studies included in this review are summarised in Table 1.…”

“…However, blinding is virtually impossible in trials of psychological therapies as patients and therapists are aware that therapy is taking place. Four of the total 16 studies [49][50][51]55 did use a blinded assessor to assess outcome and this is noted in appendix 3 (see Table 22). Even the use of a blinded assessor is difficult in studies of psychological therapies because self-assessment scales are often used.…”

“…Five studies included fewer than 30 patients. 49,54,56,58,61 Seven studies had between 30 and 80 patients, 50,52,57,60,[62][63][64] and four studies had more than 80 patients. 51,53,55,59 Four authors mentioned the use of power calculations being used to determine sample size 52,53,55,59 but only two studies were adequately powered.…”

“…49,52,58,60,62,63 Study site, follow-up and inclusion/ exclusion criteria Appendix 3 describes the study site, follow-up and inclusion/exclusion criteria of the 11 RCTs and the five non-RCTs (Tables 26 and 27). Study site and setting: Three studies took place in Australia, 54,56,62 nine in the UK, [50][51][52][53]55,58,59,61,63 and three in the USA. 49,60,64 One study was a multicentre trial with centres in the UK and the USA.…”

“…Eleven studies reported that at least some patients had had previous therapy or medication for their condition. 50,51,53,[55][56][57][58][60][61][62][63] Duration of illness was reported in nine studies. 51,[54][55][56][57][58][60][61][62] Baseline comparability: Information on baseline comparability (no significant difference for important variables before treatment) is only relevant for the 11 RCTs included in the study.…”