"The long-held belief that improvement in psychotherapy requires a relationship with a therapist may be true for some patients."—Dr. Isaac Marks, British Journal of Psychiatry, 2007
England is crazy, and so am I.
Because she is older and larger, let's start with England. In June 2006, a policy group at the London School of Economics led by Lord Richard Layard, a Labor peer, economist, and the author of Happiness: Lessons From a New Science, announced that mental illness was incapacitating the country. At the time, 1 million Brits were receiving disability benefits due to depression and anxiety, resulting in untold misery and an annual drain on the GDP of 17 billion pounds. The government already knew how to combat this scourge: A national agency had earlier determined that cognitive-behavior therapy, which teaches people to modify their dysfunctional thoughts, beliefs, and behaviors, was the most cost-efficient, long-lasting treatment for many common psychiatric disorders. The problem was that there were far too few therapists to go around. The nation was facing a craziness backlog.
Now me. Nine months ago, my wife gave birth to our first child, a spirited, wide-eyed girl whose arrival has brought unmitigated joy. Yet, as we almost immediately discovered, with parental joy comes innumerable costs, the first and highest of which is sleeplessness. For nearly four months, in an often futile attempt to soothe our fussy daughter, my wife and I spent several hours each night bouncing up and down on a giant blue exercise ball—the blinds drawn, the lights out, and all communication in whispers, as if we lived in a giant Skinner box. I speak only for myself when I say that, consequently, all natural tendencies toward mental disorder came rushing to the fore. I grew irritable, gloom-ridden, beset by a nagging, directionless worry. These symptoms were hardly unfamiliar—I'd been in therapy for them before, most successfully, in fact, with CBT—but a number of factors, among them inadequate mental-health benefits and the drying-up both of my freelance work and my free time, blocked any access I had to the talking cure. I needed help, but had no way to get it.
It is here that England's needs and my own coincide. Only 10 weeks into parenthood and already depleted, I discovered that the British government had recently embarked on a novel experiment in health care delivery. In order to bridge the gap between psychotherapy demand and supply, it had directed the National Health Service to begin making available therapy conducted not by a psychiatrist, psychologist, or social worker but by a computer program. Computerized cognitive-behavior therapy, delivered either over the Web or by software, was one-quarter as expensive as face-to-face therapy, according to one estimate, and if widely used would save the government as much as 136 million pounds a year. In March of 2007, the Department of Health mandated that cCBT be disseminated to all 153 medical "trusts" in the NHS system. Anxious, increasingly desperate, and intrigued, I considered that there was no good reason why the British government's mandate should not extend to a sensory-deprived, stressed-out citizen of its ally and former colony, and with eager anticipation, I turned to my laptop for help.
According to an editorial published recently in the British Journal of Psychiatry by Isaac Marks, a venerable fixture of the Institute of Psychiatry in London, there are currently 97 computerized psychotherapy programs in existence. These programs have been designed to treat a range of disorders and problems, including obsessions and compulsions (BT Steps),the development of eating disorders in youths (Student Bodies), sexual dysfunction (Sexpert, now defunct), and, improbably, encopresis, a disorder characterized by defecating in inappropriate places (UCanPoopToo). So far, the British government has endorsed only the two of these programs for which it has deemed there are good clinical data to support their effectiveness: the muscularly titled Beating the Blues, for mild-to-moderate depression, and FearFighter, for phobia, panic, and anxiety.
Given the nature of my complaint, I opted for the latter and got in touch with CCBT Ltd., the London-based company that licenses the system. The company's management was strangely cagey; they were at first willing only to send me a brochure replete with vague statistics ("FearFighter™ has undergone extensive testing and trials, involving 700 patients. …") and patient endorsements ("To date I've travelled on the underground train [200 feet below ground] without a twinge of anxiety—I still can't believe it!"). Eventually, however, prodded by my claims of journalistic necessity, they granted me access, though with limitations. Most patients work through the program—a Web-based system you log on to with a username and password—in eight to 12 weeks. I was given only four, and I would not benefit, as local patients do, from "6 calls from a support worker, lasting in 5 to 10 minutes duration." No, there was to be no tech support for the American sufferer! Still, something was better than nothing, and shortly after the company gave me my password, I logged on for the first time.
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