Online Psychiatric Treatment Programs

According to study results presented on Wednesday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies, sleep in adults can be significantly improved with a six-week cognitive behavioral intervention for insomnia delivered via the Internet. Participants in the study who received the intervention experienced increases in total sleep time of 80 minutes, compared to just nine minutes in the control group. “We believe these types of Web-based treatment programs have the potential to impact countless individuals around the world,” said author Lee Ritterband, PhD, of the University of Virginia. “Specifically related to insomnia, the availability of non-pharmacological help is significantly lacking. The Internet has already become a critical source of healthcare and medical information. The Internet may prove an effective tool to more broadly disseminate cognitive behavioral therapy for insomnia.” Aside from being specific to insomnia, the idea that Web-based treatment for a psychiatric issue is beneficial is certainly nothing new.

Previous Studies

The November 2007 issue of the American Journal of Psychiatry features study results that show an eight-week program of cognitive behavior therapy (CBT) delivered via the Internet achieved greater reductions in PTSD and depression among military service members than Internet-based supported counseling. In the study, 25% of those who received cognitive therapy no longer had a diagnosis of PTSD following treatment or at 6-month follow-up, compared to 5% after treatment and 3% at follow-up for those assigned to supportive counseling. “We are very encouraged by the results, especially because we demonstrated that service members with PTSD, who may not have the time or inclination to seek formal therapy, can get the help they need,” said lead author Bret Litz. “Because self-management CBT respects the ability of service members to help themselves with structure and encouragement, and because the program is private and framed as training, it has the promise for overcoming some of the barriers that prevent many service members from seeking and receiving mental health services.”

Noting that the “efficacy of Web-based self-help approaches for anxiety disorders has been demonstrated in a number of controlled trials,” the authors of a study in the March 2005 issue of the Journal of Medical Internet Research sought to “examine the use and longitudinal effectiveness of a freely available, 12-session, Web-based, cognitive behavioral therapy (CBT) program for panic disorder and agoraphobia.” Although just 1.03% of 1,161 people who registered with the site actually completed the 12-week program, the authors found statistically significant reductions in self-reported panic attack frequency in those who didn’t complete the program; participants who completed just three sessions reduced average attack numbers per day from 1.03 in week two to 0.63 in week three.

So, the results are there. Psychiatric patients who stick with an online self-help program can expect significant changes in their symptoms. But why? Is it because interacting with a computer is less embarrassing than with a live physician or other healthcare provider, allowing the patient to be more open and truthful in providing personal information? (see my Web exclusive from last week, “Behavior Screening Via Computer” for more on this). Is it because sitting down at the home computer is much more convenient than driving to the psychiatrist’s office? Is it a combination of these? Or is it something completely separate? Post a comment below and tell me what you think.

My parting questions to you are: Do you want your patients participating in self-help online programs? Are they all reliable? Do they take away from your job? Certainly those programs in which the physician is directing the patient to the program online would be preferred. But what about those that offer these programs directly to patients without your involvement, like MySelfHelp.com and UniversalClass?

I’d love to hear your feedback, and can only assume your colleagues would, too.