Academic journal article American Journal of Psychotherapy

Development and Initial Testing of a Multimedia Program for Computer-Assisted Cognitive Therapy

Academic journal article American Journal of Psychotherapy

Development and Initial Testing of a Multimedia Program for Computer-Assisted Cognitive Therapy

Article excerpt

Development and Initial Testing af a Multimedia Program for Computer-Assisted Cognitive Therapy*

A multimedia program for computer-assisted psychotherapy has been developed to help patients learn cognitive therapy skills. The program is designed to provide psychoeducation, teach self-help methods, and give information to clinicians on the patient's progress in using the software. Multimedia technology is utilized to engage users in the learning process and to make the program accessible for persons who do not have computer or keyboard skills. A preliminary study with 96 subjects who used the software along with treatment as usual found that 75 (78.1%) completed the entire program. Users indicated a high rate of acceptance of this form of computer-assisted therapy, and mean scores on a measure of cognitive therapy knowledge were significantly improved.

INTRODUCTION

It has been suggested that computer programs for psychotherapy could have a significant positive impact on the cost and/or availability of mental health services (1, 2). However, only a few programs have been tested and made available for clinical use. Early studies examined the possible utility of software that only displayed text, such as a computer program for self-directed exposure therapy (3) and a psychoeducational program for cognitive therapy (4, 5). More recently, technological advances, such as multimedia (6), interactive voice response (7), hand-held computers (8), and virtual reality (9), have been incorporated into computer programs for psychotherapy.

Although concerns have been raised about possible negative effects of having humans interact with a machine as a component of therapy and about the limitations of computer programs in communicating with patients (1, 2, 10, 11), most studies have found that patients readily accept computer tools for psychotherapy (2, 7, 12). For example, Colby et al. (2) reported that 219 (79%) of 278 users of their text-based program reported a high level of satisfaction, and Marks et al. (7) observed that 71% of subjects who used an interactive voice response system for obsessive-- compulsive disorder noted that the program improved the quality of their lives. A counterpoint to the favorable reports on computer-assisted therapy was registered by Stuart and LaRue (13) who found that severely depressed inpatients had difficulty using a computer program that attempted to simulate patient-therapist communication.

There has been limited research to date on the efficacy of computer-- assisted therapy (14), but available evidence suggests that computer-- assisted therapy of different types can be useful for depression (5), anxiety disorders (3, 8, 9, 15), and OCD (7). To date, there have been no reports of patient acceptance or efficacy of multimedia programs for computer-- assisted therapy. Demonstration of patient acceptance and tolerance of computer-assisted therapy is a necessary step before initiating randomized, controlled trials. In this report, we describe the development and initial testing of Cognitive Therapy: A Multimedia Learning Program (6), the first multimedia program for computer-assisted psychotherapy. The aims of the research study described here were to: 1. determine acceptance of computer-assisted therapy by patients who used the computer program along with treatment as usual, and 2. pilot outcome measures for learning cognitive therapy skills and measuring treatment efficacy to be considered for later randomized, controlled investigations.

PROGRAM DEVELOPMENT AND CONTENT

Our review of other programs for computerized cognitive therapy suggested that earlier software, such as programs developed by Selmi and colleagues (5) and Colby and Colby (16), might not have broad applicability because of a complete reliance on written text to communicate with the patient. Familiarity with computers, keyboard experience, and ability to sustain high levels of concentration appeared to be important factors in the suitability of these programs for clinical use. …

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