The very idea of psychotherapy seems to defy the instant-access, video screen chatter of popular digital culture.
Not for lengthy, if some scientists have their method. previously few years researchers were testing simple video-game-like systems aimed at relieving not unusual issues like nervousness and depression. these latest results were encouraging enough that investigators at the moment are delivering the programs on smartphones — remedy apps, in effect, that may quickly make psychological help accessible every time, anywhere, whether or not within the grocery retailer line, at the bus or just before a piece presentation.
The prospect of a therapy icon next to Angry Birds and Fruit Ninja is stirring as much dread as hope in some quarters. “We are built as human beings to figure out our place in the world, to construct a narrative in the context of a relationship that gives meaning to our lives,” said Dr. Andrew J. Gerber, a psychiatrist at Columbia University. “I would be wary of treatments that don’t allow for that.”
The upside is that well-designed apps could reach millions of people who lack the means or interest to engage in traditional therapy and need more than the pop mysticism, soothing thoughts or confidence boosters now in use.
“That is what makes the idea so promising,” said Richard McNally, a psychologist at Harvard whose lab recently completed a study of 338 people using a simple program accessible on their smartphones. “But there are big questions about how it could work, and how robust the effect really is.”
The smartphone examine is best some of the up to date tests of an method known as cognitive bias amendment, or C.B.M., that seeks to break one of the crucial brain’s dangerous habits. the idea, pioneered via Colin MacLeod of the college of Western Australia, is straightforward. consider folks with social anxiousness, a kind of extreme shyness that can leave people breathless with dread. studies have discovered that many that struggle with such anxiousness fixate subconsciously on adversarial faces in a crowd of folks with mostly comfortable expressions, as though they see handiest the dangerous apples in a bushel of most commonly good ones.
Modifying that bias — that is, reducing it — can interrupt the cascade of thoughts and feelings that normally follow, short-circuiting anxiety, lab studies suggest. In one commonly used program, for instance, people see two faces on the screen, one with a neutral expression and one looking hostile. The faces are stacked one atop the other, and a split-second later they disappear, and a single letter flashes on the screen, in either the top half or the bottom.
Users push a button to identify the letter, but this is meaningless; the object is to snap the eyes away from the part of the screen that showed the hostile face, conditioning the brain to ignore those bad apples. That’s all there is to it. Repeated practice, the researchers say, may train the eyes to automatically look away, or the frontal areas of the brain to exercise more top-down control.
“It’s a little boring, because it’s repetitive, but you’re only doing it for a few minutes a few times a day,” said Stefanie Block, 26, a University of Michigan graduate student who took part in the Harvard study while living in Boston. “I just did it when commuting to work on the subway; it’s crowded, there isn’t much you can do, it was the perfect time.”
In lab experiments, some researchers have gotten very strong results, “with effect sizes like you’d see in regular therapy,” said Nader Amir, a psychologist at San Diego State University. In a series of experiments, Dr. Amir has found that about half of people with an anxiety disorder who complete a full course — practicing on a computer for about 30 minutes twice a week, for four to six weeks — improve enough that the diagnosis no longer applies. He has tested programs that target social anxiety and generalized anxiety disorder and is part owner of a company that is marketing the technology.
A look at among 40 youngsters with power anxiety, published in December, found that a identical attention bias program produced “important reductions in the choice of anxiety symptoms and symptom severity,” in step with the authors, who included Dr. Daniel Pine of the nationwide Institute of psychological well being and Yair Bar-Haim of Tel Aviv university.
Psychologists in Europe have even tried a bias modification program aimed at heavy drinking — a computer task in which people push away images of alcoholic drinks, using a joystick, and zoom in on nonalcoholic ones — and found that it improved the effectiveness of talk therapy aimed at reducing the habit.
Other researchers have not had quite the same success. “I am far from convinced that this is for real,” said Willem Van der Does, a psychologist at Leiden University in the Netherlands, who has several papers under review testing bias modification.
“I did not notice any positive effect,” one woman with social anxiety who participated in the Harvard study said in an e-mail. “It seemed similar to when I played Scramble or other games on my phone.”
In a review of studies of bias modification, researchers at the University of Pennsylvania concluded last year that the technique had a small effect that “significantly modified anxiety but not depression.” The authors noted that there was evidence of what scientists call a “file drawer” problem — in which studies finding no effect are filed away or ignored, while encouraging ones are published. “I think in this field the standards for publishing positive studies are lower than for negative ones,” Dr. Van der Does said in an e-mail.
It is perhaps fitting that the largest study to date — by Phil Enock, a graduate student at Harvard; Stefan Hofmann, of Boston University; and Dr. McNally — produced results that were both encouraging and confusing. The team began recruiting participants in the summer of 2010, using Craigslist and online bulletin boards for social anxiety.
In March 2011, they were flooded, after an article in the Economist magazine about cognitive bias modification mentioned the project. Months later, after 338 participants with anxiety symptoms that ranged from mild to severe completed a total of more than 4,000 sessions of the two-face therapy application, the researchers had some results.
Participants who were given the remedy progressed their ratings on a questionnaire measuring anxiousness, losing via a standard of twenty-two issues, compared with an 8-point drop amongst folks in a “waiting record” group, who got no pc video games to play. on the other hand, a placebo group within the observe practiced with a -face video application not supposed to shift the eyes from one face or the other, and their anxiety ranges as measured on questionnaires additionally fell via about 22 points, simply as that they had for those who got the treatment.
Karin Langer, 34, an architectural historian in Chicago who scored high on some measures of social anxiety, was among those who seemed to improve using the app. Ms. Langer works at home, interacts almost entirely by e-mail, and found herself increasingly anxious about phone conversations with colleagues. “I did notice a difference after using the therapy,” she said. “But it may have been due to a placebo effect. I felt good about myself, that I was doing something for my issues, and a lot happened in those two months outside the study that could have helped.”
Stranger still, the people who reported that they had learned about the study from the Economist article responded very well to the program — whether getting the treatment app or the placebo one — as if the article itself had some power of suggestion.
“We’re now not precisely excited about that finding; we have no thought what it approach,” mentioned Mr. Enock, including that there is nonetheless a lot of work to do to decide who absolute best responds to which explicit form of bias modification, and the way strong the impact truly is.
however, he said, “We without a doubt have shown that you can deliver remedies on smartphones, you can placed consideration and bias modification gear actually in other folks’s fingers, and there’s no explanation why to hold back” from trying out them.