Posts Tagged ‘Psychotherapy’
The ability to choose an evidence-based psychotherapy on the base of scientific knowledge has been a negligible factor in the evolution of the human brain. One could argue that empirical science itself fosters a style of thinking that is counter-intuitive for many of us. Personally I believe that the human way of trying to identify causal relations in a chaotic universe is the main reason of the evolution our kind has taken in the last few thousand years. But our susceptibility to see causal relations can also be a big problem. Thus I believe the main reason why fad therapies can book so much success is that the human mind is not made to think empirically. And if people do think the scientific way there are lots of downfalls, because the empirical science we have today is far from perfect and methodological problems lurk around many corners. It is easy to express (warrant) criticism of the scientific method (which currently is strongly connected to positivism) and shake up people’s reality. This can be a good thing, if you want to get people start thinking themselves, but far more often those who condemn the scientific system propose to let go of all empirical science altogether and adopt a system of their own choice. Funny enough these systems often try to build on the credibility of science, but in the end are not provable.
Whereas in the field of medical health, imbalanced can often be cured by the ingestions of medication, the parallel in the mental health would be ingestion of new thoughts in order to resolve psychic imbalance. While the body can react quickly to changes in the system, the plasticity of the neuronal structure is less flexible. Ingestions of new mental processes need to be repeated many times in order to change the underlying biological substrate. While most people understand that the process of loosing weight requires constant attention to food intake and regular exercise, most people do not understand that mental change is comparably slow. When a “quick and easy” fix is offered, people hope to circumvent the long trajectory of psychotherapy.
To sum it up (and two minor new points):
- The human mind is not made to think in a scientific way.
- Problems with the scientific method often lead people to turn to religion/quick’n’easy solutions/fad therapies.
- Normal therapy usually takes time, money and is painful.
People love to fall for the “it’s easy and painless” trick
- Many conditions do not have a real “cure”. Some can not accept that.
- Authority figures support fads and get rich doing so.
Elements of scientific approach violated in fad therapies
If any given theory is considered scientific (within the current paradigm), this usually means that it is objective, testable and replicable. There are different ways in which fads can be non-scientific. Mostly they are scientific in some ways, but not in all. Here are some of the preferred ways of fads for being non-scientific:
- There is no operational definition, no specifications of the processes and how they are related to important constructs and variables.
- There is no theory at all.
- The cause and effect relationship between the characteristics and consequences of environmental events and experiences has not been researched using sound methodology.
- Causal relationships are presumed without any reason or people are made to believe that there is a causal relationship by presenting correlational evidence.
- Alternative explanations are not pursued.
- Effects are generalized without reason to do so.
- Evidence is subject to biases.
- Unwarranted predictions are made.
Internet-based psychotherapy is a hot topic since a few years. The main advantage is money: Computers are much cheaper to run than licensed psychotherapist. So if a computer could achieve the same or nearly the same treatment outcome as a human expert this would be a huge advantage, as computer systems can be replicated almost infinitely (and once the program is written at almost no costs). We have to keep in mind that for political and economical decision making the effect size is not the only important factor. When considering which project to found something like “effect size“ / costs is more appropriate. In times of long waiting lists and many people without health insurance, cheap treatment means reaching more people. Another advantage is that physical boundaries are not important anymore. If a specialist for a specific therapy is 1000km away it just does not matter anymore. Furthermore the possibilities for comprehensive care, by involving personal with different expertise (social workers, psychologists, physicians) can be achieved by using the internet as a medium.
On the other hand there are some drawbacks. Privacy is a difficult factor as digital information is much more vulnerable than a handwritten dossier. Traffic which uses the internet (and not some special intranet) is always at risk, not to mention the risks on the computer of the client and therapist itself (viruses, Trojan horses, etc…). Face to face contact also offers additional information about the client (non-verbal communication, punctuality, interaction with other patients/staff members) that are lost in a digital environment. Therapeutic alliance is also more difficult to achieve in purely internet-based psychotherapies. I believe that ultimately internet-based therapy will play huge role in mental health care, especially in the concept of stepped-care. There are many ways to use computers and the internet to improve on the (very expensive) system we have today, but face to face therapy will always be an important part of every sever disorder, as (disturbed) human interaction often lays at the core of the problems. That said, we should try to develop digital forms of psychotherapy because not only will that give access to important help to much more people, but we will also be able to learn about the therapeutic process from that experience. In turn that will also increase efficiency of traditional psychotherapy and supply us with new hypothesis and theories.
http://www.vrphobia.com (which turned up as #1 in Google) is an organization that is called Virtual Reality Medical Center. They treat all kinds of anxiety related disorders, but seem to focus mainly on specific phobias. After the intake session the client is taught skills to suppress automatic fear reactions. In the following sessions the client is gradually exposed to the feared stimulus. In other words: VR desensitisation.
Obesity and addiction have some common properties. This research seeks to integrate some findings of addiction research into eating disorder therapy. In that light they make use of VR for distinct goals: Help the client to experience the own body in situations that are normally avoided. This experience is supposed to have influence on body perception and also empower the client. In the VR patients came “face to screen” with their personal risk situations (supermarket, gym, etc…) and could train emotion regulation and problem-solving skills in a save environment. The randomized clinical trial seems to indicate that the ECT group did indeed better than standard CBT.
As http://www.cybertherapy.info/cybertherapy/8_Optale.pdf shows also psycho-dynamic therapists start to see the merits in using new technology. Erection dysfunction and premature ejaculation are treated in a virtual environment (the porn industry will love that application) together with standard psychotherapy. The possibility to enact the new strategies in a save and private environment is supposed to speed up the therapeutic process. First clinical trials seem to indicate that this might indeed work for some clients, also it is not clear for whom exactly. Sample size is not adequate in study 1, power is much stronger in study 2. Results are not telling a clear story (yet?).
By the way:
http://www.cybertherapy.info/ is the most comprehensive and excellent source for material about VR in psychotherapy that I could find on the net. Especially have a look at the free books, like http://www.cybertherapy.info/pages/book2.htm or http://www.cybertherapy.info/pages/book3.htm. The articles are downloadable as PDF (just scroll down). Especially look at book 3 session 2 that comprises some clinical controlled trials with cybertherapy (which seems to be the keyword I was desperately looking for).