Therapist Contact and Outcome of Self-exposure Treatment for Phobias

Abstract

Eighty-four chronic phobic patients were randomly assigned to self-exposure in vivo instructed by either a psychiatrist, a computer or a book; mean therapy time per patient was respectively 3.1, 3.2 and 0 hours. Seventy-one patients completed treatment. All three groups improved substantially and similarly to 6 months follow-up, with no significant difference between them; self-exposure treatment was effective even without therapist contact. Among the three groups, initial expectation of help and positive attitude to the psychiatrist were equally high and related to subsequent rating of help received. All three groups rated the psychiatrist as more tolerant, reliable, and understanding than the computer or book, but these attitudes did not relate to outcome, were initially similar among all three groups, and changed minimally at 6 months follow-up.

Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment

“…At present the media are fascinated by accounts of exceptional strategies used by individual survivors instead of promoting proven strategies of benefit to many. Professionally guided self-treatment by books, computer programs and self-help groups have been proven in randomized controlled trials to be efficacious (37,38). Health services should recognize the need to fund professional input to such self-treatment strategies.…”

Computer‐Aided Psychotherapy for Anxiety Disorders: A Meta‐Analytic Review

“…Only eight reported allocation to conditions by an independent party. Blinding of assessors was reported in seven studies (Bornas, TortellaFeliu, & Llabrés, 2006;Carlbring et al, 2005Carlbring et al, , 2006Ghosh et al, 1988;Greist et al, 2002;Marks et al, 2004). Dropout ranged from 2 to 29% (two studies did not report dropout; Bornas, Tortella-Feliu, Llabrés, & Fullana, 2001;Hassan, 1992).…”

“…Some CP systems are as effective as face-to-face care despite requiring far less therapist time (e.g. Carlbring et al, 2005;Ghosh, Marks, & Carr, 1988;Kenardy, McCafferty, & Rosa, 2003;Marks, Kenwright, McDonough, Whittaker, & Mataix-Cols, 2004). They may also speed access, allow patients to work at their own pace, and abolish the need to schedule appointments with a therapist .…”

Psychotherapy by computer

“…At present there are three main modes of delivery of computer-aided care: internet access (Feelbetter), telephone-accessed interactive voice response systems (COPE and BTSTEPS) and free-standing computers (FEARFIGHTER and Beating the Blues). Users feel that computer responses are empathic and understanding (Weizenbaum, 1976;Ghosh et al, 1988) and that non-human instructions can be as therapeutic as human ones (Ghosh et al, 1988;Selmi et al, 1990;Schneider et al, 1995). To date, however, no survey has been undertaken to look at potential service users' preferred method of delivery of computer-aided therapy.…”