Is Internet-based mental health care as effective as in-person therapy?

 

Cognitive Behavioral Therapy Online

 

Internet-delivered cognitive behavioural therapy (CBT) is not recommended for severely ill patients, and research findings do not support a DIY approach. (istockphoto)

 

Let’s say you’ve been down in the dumps for months, but are leery of taking psychiatric drugs. Your doctor may recommend cognitive behavioural therapy (CBT), a form of “talk therapy” that focuses on changing the underlying thought patterns and distorted perceptions that perpetuate the “stinkin’ thinkin’” brought on by mood disorders. Several trials have shown that CBT is just as effective as medication, and highly successful in treating mild to moderate depression and anxiety. But what if you don’t have the time or money to see a therapist?

You could go online. In the past 10 years, dozens of Internet-delivered CBT programs have cropped up, many of them free of charge. In countries such as Australia and Britain, computerized CBT is being touted as a cost-effective way to treat greater numbers of patients suffering from the most common mental illnesses – mild to moderate anxiety and depression.

But is online CBT as effective as face-to-face sessions with a compassionate therapist? Advocates note that some patients prefer the anonymity of Internet-delivered CBT, even as they acknowledge that the treatment model still needs tweaking. Critics insist that mentally ill patients need the human touch. Both agree that more research is needed, but as things stand, here are the promises and pitfalls of psychotherapy at your fingertips.

How does it work?

Using a computer, tablet or smartphone, patients log on to an online program such as Beating the Blues or MoodGYM (which has at least 600,000 registered users worldwide). At their own pace, patients complete interactive modules on how to identify symptoms, set goals and find new ways of thinking about everyday events. For example, a module might teach the “three Cs”: Catch the unhelpful thought (“I am an idiot for forgetting my friend’s birthday”). Check it to identify the distorted thinking pattern (over-generalizing, focusing on the negative). Change it to a more accurate or helpful thought (“Everyone makes mistakes,” and “I am a good friend most of the time”). Online CBT programs may include quizzes, homework exercises and self-assessments to monitor progress.

Does it help people recover from mental illness?

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How to Move on From a Seemingly Horrific Incident

 
Gregg McBride
Source: Gregg McBride

It wasn't so long ago that I was physically attacked while walking to the gym one morning. This was during a walk I had been making for over three years at the time—and although I knew the neighborhood I was living in was a bit on the "edge," I never expected anything like this attack to happen. Granted, it was very early in the morning (before 5 a.m.)—a time of day that I've since learned that (sadly) no one should be walking by themselves.

Still, I had always been cautious when out at such an early hour. And on the day that this incident happened, I could hear noise coming from two rowdy guys sitting on a curb in the middle of the block I happened to be on. Using common sense, I crossed the street (from the side they were on) and continued on my way. I didn't have far to go—only about two more blocks until I would reach the gym I belonged to.

When I noticed one of the guys running over to me, I could tell from his somewhat manic behavior that there was going to be trouble. These two guys were not vagrants and didn't even look to be criminal types. They did, however, seem to be very high on some kind of substance. The guy crossing over to me kept asking, "Where are we? Where are we?"

How Distorted Thinking Increases Stress and Anxiety

10 cognitive distortions that make things worse for us.

 

 

I learned about cognitive distortions in the 1990s from a book by David Burns called Feeling Good: The New Mood Therapy. I’d just moved from the faculty wing at U.C. Davis’ law school to serve as the dean of students. I knew how to teach law…but I didn’t feel competent to help students who were struggling emotionally.

 

When I shared my concerns with a friend who was a therapist, she recommended Feeling Good. She said it would help me recognize when a student was engaged in distorted thinking patterns that were increasing his or her stress and anxiety. I don’t know who benefitted more from the book: the students I was trying to help or me personally!

 

Many years later, after I became chronically ill, I found the notes I’d taken on ten cognitive distortions that Burns discusses in Feeling Good. I immediately realized that I had a new life challenge to apply them to. I’m indebted to him for this piece. I’ll describe each cognitive distortion and then include a suggestion or two for how to counter it.

 

 

Of course, before you can counter distorted thinking, you have to become aware that you’re engaging in it. To this end, it might be beneficial to make a list of the ten distortions and then look it over every few days. Or, you could write down some of your stressful and anxious thoughts and then look to see which of the ten distortions they fall under.

 

In my examples, I’ll focus on distortions that the chronically ill are prone to, but those of you who are in good health can substitute a word or two and I’m confident you’ll recognize yourself in these examples.

 

 

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Why Won’t You Take Your Medication?

 

by Pete Earley

“Why won’t you just take your medication? I take pills for my cholesterol every night and its no big deal?”

“Every psychiatrist we’ve seen has said you have a mental illness. Why won’t you accept it? Why would the doctors tell you that you’re sick, if it weren’t true?”

“Let’s look at when you were doing well and when you got into trouble. What was the difference? Medication. It was the difference. When you were on your meds, you were fine. And when you weren’t, you got into trouble. Can’t you see that?”

These quotes may sound familiar to you if you are a parent and have a a son or daughter with a severe mental illness. I’ve said everyone of them to my son, Mike.

It often is frustrating for us – parents — to understand why our children will not take anti-psychotic  medication or take it only until they get better and then stop. The remedy seems so clear-cut to us, so simple – and watching them experience the mania, depression, and delusions that happen when they become psychotic is heartbreaking and horrific.

Early on, I tried every trick out there to get Mike to take his pills. Those of you who have read my book know that during one of his first breakdowns, I crushed his pills and mixed them into his breakfast cereal only to be caught by him. I snuck into his room and counted his pills too one day and when I discovered that he had stopped taking them, I followed the advice of a therapist who had told me that I needed to practice “tough love.” I told Mike that if he didn’t take his medication, he had to move out of my house. He did – that very same day.

Another time, I offered to pay him to take his medication — a $1 per pill.

Xavier Amador
It was my friend, Xavier Amador, author of the book, “I’m Not Sick, I Don’t Need Help” who finally convinced me to back off. “I can promise you, Pete,” he said, “your son knows exactly how you feel about medication. You don’t need to ever mention it to him again.”

And since that day, I haven’t. Not a word.

So why do persons with mental illnesses refuse to take their medication or stop taking them as soon as they become stable?

I am asked that question more than any other after I give a speech.

Let’s skip the obvious reasons –that some anti-psychotic medications can dull a person, make them feel physically lousy, kill their sex drive, cause them to gain weight or send them to bed exhausted even though they are already sleeping for 16 hours a day. Let’s ignore the fact that no one really knows the long term health impact that medication can cause on a person’s body.

Instead, let’s dig deeper.

One day, I asked Mike to explain to me in writing why he had struggled so much when it came to taking his medication.

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You, New and Improved

      Want to change? How to get to a new you.

                               Self-Esteem vs. Self-Acceptance

 

The Path to Unconditional Self-Acceptance

How do you fully accept yourself when you don't know how?

 

 

 

 

 

 

Though related, self-acceptance is not the same as self-esteem. Whereas self-esteem refers specifically to how valuable, or worthwhile, we see ourselves, self-acceptance alludes to a far more global affirmation of self. When we're self-accepting, we're able to embrace all facets of ourselves–not just the positive, more "esteem-able" parts. As such, self-acceptance is unconditional, free of any qualification. We can recognize our weaknesses, limitations, and foibles, but this awareness in no way interferes with our ability to fully accept ourselves.

 

I regularly tell my therapy clients that if they genuinely want to improve their self-esteem, they need to explore what parts of themselves they're not yet able to accept. For, ultimately, liking ourselves more (or getting on better terms with ourselves) has mostly to do with self-acceptance. And it's only when we stop judging ourselves that we can secure a more positive sense of who we are. Which is why I believe self-esteem rises naturally as soon as we cease being so hard on ourselves. And it's precisely because self-acceptance involves far more than self-esteem that I see it as crucial to our happiness and state of well-being.

 

 

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