By TINA ROSENBERGElle is a mess. She’s actually talented, attractive and good at her job, but she feels like a fraud — convinced that today’s the day she’ll flunk a test, lose a job, mess up a relationship. Her colleague Moody also sabotages himself. He’s a hardworking, nice person, but loses friends because he’s grumpy, oversensitive and gets angry for no reason.
If you suffer from depression or anxiety as Elle and Moody do, spending time with them could help. They are characters in a free online program of cognitive behavioral therapy called MoodGYM, which leads users through quizzes and exercises — therapy without the therapist.
Cognitive behavioral therapy is a commonly used treatment for depression, anxiety and other conditions. With it, the therapist doesn’t ask you about your mother — or look at the past at all.
Instead, a cognitive behavioral therapist aims to give patients the skills to manage their moods by helping them identify unhelpful thoughts like “I’m worthless,” “I’ll always fail” or “people will always let me down.” Patients learn to analyze them and replace them with constructive thoughts that are more accurate or precise. For example, a patient could replace “I fail at everything” with “I succeed at things when I’m motivated and I try hard.” That new thought in turn changes feelings and behaviors.
The success of cognitive behavioral therapy is well known; many people consider it the most effective therapy for depression. What is not widely known, at least in the United States, is that you don’t need a therapist to do it. Scores of studies have found that online C.B.T. works as well as conventional face-to-face cognitive behavioral therapy – as long a there is occasional human support or coaching. “For common mental disorders like anxiety and depression, there is no evidence Internet-based treatment is less effective than face-to-face therapy,” said Pim Cuijpers, professor of clinical psychology at the Vrije Universiteit Amsterdam and a leading researcher on computer C.B.T.
MoodGYM, the pioneer, was developed by Australian psychologists in 2001. Now there are several similar programs in wide use and with good evidence behind them (and lots of junk programs that are completely ineffective).
MoodGYM and its kin are important because untreated mental illness is a huge global problem. Depression is the leading cause of disability for women worldwide, and the second-leading cause for men. If medical care is hard to come by in much of the world — in rural Indiana as well as rural India — mental health care is often impossible to get. In the United States, at least half of major depression goes untreated, and in very poor countries the figure is close to 100 percent.
Why don’t people get treated? Many don’t know they have a treatable disease, or don’t believe that treatment will help them. Some know they have a problem, but the stigma of mental illness keeps them from facing it and seeking help.
Online therapy can’t do much about those barriers. But it can help people who stay sick because there are no therapists nearby, who fear being judged or embarrassed in therapy, who can’t take time off from work, or for whom the cost of treatment is too high. It allows people to carry therapy around in their pockets, use it at 2 a.m., and pay nothing or nearly nothing.
In the late 1990s, Helen Christensen, a mental health researcher at the Australian National University in Canberra, and her colleague Kathleen Griffiths worked with local designers to create MoodGYM, which was adopted by Australia’s national health system six years ago. Christensen is now the chief scientist at the mood-disorder research Black Dog Institute (named after Winston Churchill’s famous term for his own depression), where she researches and designs more online programs. Among these are BiteBack for teenagers and MyCompass, which aims to treat anxiety, stress and depression in mature adults (MoodGYM is pitched younger, although older people use it, too). MyCompass is designed in small chunks, “something you can do at the bus stop on your mobile phone,” said Christensen. Both are available to anyone with a computer worldwide.
MoodGYM was controversial when it first came out. “People did feel threatened,” said Christensen. “They said it’s unethical, harmful – you’re doing damage and you don’t know it. Or you’re stopping people from getting the real help they need.”
But MoodGYM has been widely successful, without the predicted consequences. About 100,000 Australians use it each year, as do people in 200 countries.
Australia is ground zero, but other online cognitive behavioral therapy programs are also widely used in the Netherlands, Sweden and Britain. In 2007, the British National Health Service began covering a program called FearFighter for phobias and anxiety, and another program,Beating the Blues, for depression. Both can be used for no cost through participating National Health Service doctors, or bought to use alone. Beating the Blues costs the equivalent of $237. FearFighter is $154, or $313 if you want telephone support from clinicians. In a medical setting, most doctors use online therapy in what’s called a stepped model. Patients with mild to moderate problems start with the computer program, checking in every so often with a therapist or case manager. Those who don’t get better are then treated face to face by a therapist and, if that doesn’t work, by a specialist. (Patients with very serious issues start with in-person therapy.)
Online therapy is effective against an astonishing variety of disorders. A Swedish survey of studies found that online C.B.T. has been tested for 25 different ones. It was most effective for depression, anxiety disorders, severe health anxiety, irritable bowel syndrome, female sexual dysfunction, eating disorders, cannabis use and pathological gambling. “Comparison to conventional C.B.T. showed that [online] C.B.T. produces equivalent effects,” the researchers concluded.
Cuijpers said there were fewer studies of online therapy to treat insomnia, pain and alcohol abuse, but what’s been done has shown good effects. (Last week the Upshot published one contributor’s story of his success using online C.B.T. for insomnia.)
MoodGYM, like some other programs, can be completely self-guided. People who use these programs alone tend to see a small but significant effect — the program helps, but not as much as the same program with occasional human contact. That could be check-ins with a therapist, but it doesn’t have to be. The human could be a case manager or possibly a peer. Encouragement and support are what count, not expertise.
The main reason self-guided C.B.T. doesn’t work as well is that people tend to stop using it. The human touch encourages people to stick with it. One study of adolescents found that almost 60 percent of users stopped MoodGYM after the first module when they were working unsupported on their own. When the same program was used with monitoring and support, only 10 percent stopped.
“Well, it’s called Mood Gym,” said Marcia Valenstein, a psychiatrist at the University of Michigan Medical School who is researching online C.B.T. with peer support among veterans at the Veterans Affairs Ann Arbor Healthcare System. “Even the gym gym people are enthusiastic and go for a day or so — and then they stop.”
So how does this differ from good ol' "positive thinking"--the method that keeps popping up with new titles every few years as if it's some brilliant new discovery?
Quote:
Posted in reply to the post by Barry:
So many of us have experienced depression, including me. This looks like a very helpful new tool to help with the darkest of times.
It's too much of a leap to go from depression/despair to positive thinking. They're on opposite ends of the spectrum. This is different than "positive thinking"; it's a process to assist in changing negative perceptions. Most people aren't able to do this without some guidance. It could be from any assortment of resources, including books, tapes, workshops, friends, or a strategy like this process that provides guidelines to assist in thinking about oneself and the world in different ways, that lead to a more positive outlook.
I have a positive baseline, but when I've gotten out of balance, and become depressed due to life changes that include disabling pain, foggy brain from pain meds, and being trapped in unhealthy situations, there's no way I could will myself to think positive in this immobilizing state of mind. Eventually, sometimes after a long period, I come out of it, and return to the self I know.
One thing that can help is to spend some time volunteering, although that's the last thing anyone thinks of when they're depressed. A few years ago when I was in the thick of it, a social worker visited, and told me that I would be great at "peer counseling". I was very resistant, even though in the past I'd done peer counseling in college. I didn't trust myself to drive, so I told her if she could find a driver, I'd consider doing it. She did, and the driver was a caring person, and became a new friend. The peer counseling helped a little, but the new friend was what helped me shift to a more positive place.
Another time I was depressed, I saw a behavioral counselor who suggested that since I liked cats, I should consider volunteering at the local shelter as a "cat cuddler". I didn't know such a thing existed, and I was open to trying it. After a few weeks of making a difference in feline lives, I began to feel more positive. I stayed there for over 2 years.
Both of these activities were suggested to me. I never would have thought of them on my own. That guidance made all the difference in getting back to my normal state.
When we are down, having someone or something to reach out to is a key to clearing those black clouds that are blocking our ability to feel the life giving warmth of the sun.
If you've ever experienced depression, how did you shift it to positive thinking?
Quote:
Posted in reply to the post by occihoff:
So how does this differ from good ol' "positive thinking"--the method that keeps popping up with new titles every few years as if it's some brilliant new discovery?
06-24-2015, 03:10 PM
Barry
Re: Depressed? Try Therapy Without the Therapist
Quote:
Posted in reply to the post by occihoff:
So how does this differ from good ol' "positive thinking"--the method that keeps popping up with new titles every few years as if it's some brilliant new discovery?
CBT (Cognitive behavioral therapy) has been proven to be the most helpful treatment for depression (although Ketamine shows great promise). It's different than positive thinking. It's more like good hygiene for your thought process. When people are depressed they fall into several cognitive distortions such as "all or nothing thinking" and "overgeneralization". CBT offers a way for a depressed person to see the fallacy of their thinking. This is hugely helpful, because it's the destructive thought patterns that are often at the core of the depression.
CBT itself is fairly mechanical and simple once you get the hang of it. So much so, that the online program that the NY Times article refers to (MoodGym) can do it! But that's not to say there is no role for personal help as well. The article says that even non-trained personal assistance is very helpful, but I'm sure a trained person would be better. But still the program can be a big help and you don't have to wait till a week from tuesday to get started, nor pay it $100/hour!
06-25-2015, 10:07 PM
Maxime
Re: Depressed? Try Therapy Without the Therapist
Dear Shandi,
Sometimes depression (anxiety, insomnia, etc.) is the result/consequence of a deficiency in certain critical brain chemicals. In this case, supplementing with the precursors that feed production of these naturally occurring chemicals, can make all the difference in the world, like switching on the light in a dark room. I specialize in this nutritional therapy, which includes some dietary modification along with targeted amino acid therapy. Understanding how we unknowingly feed or deplete our brain chemistry is essential, and I educate about this as well. I will arrange some talks on the subject when I return from Europe next week (in Italy now,) but you are welcome to contact me to schedule an appointment. I will speak with anyone for 15 minutes or so to assess if this work - and our chemistry together - will benefit you.
...I have a positive baseline, but when I've gotten out of balance, and become depressed due to ...
06-26-2015, 06:30 AM
Shandi
Re: Depressed? Try Therapy Without the Therapist
Yes Maxime, I'm familiar with this kind of depression. I come from a bipolar family (mother, father, brother) so I consider myself blessed not to live with this condition. As I mentioned, my baseline is positive. I can usually trace my depression to a situation. Once that situation is changed, the depression lifts. If you've ever experienced "gas lighting" you may know what I mean, or if you've experienced extreme physical limitation as the result of an injury, or being unable to leave a torturous condition. Have you ever had anyone wake you several times a night with bright light and blaring TV?
I don't have anxiety, and have no problem sleeping. As a matter of fact, if you were to wake me, after I'd been in bed for 10-15 minutes, you'd be interrupting a dream. My mind goes still almost the minute I get horizontal, but images start to appear, which are the beginnings of my dream world.
I can appreciate the fact that chemicals can and do play a large part in our thoughts and feelings. One chemical I've taken that seems to help is 5-HTP. I also take DHEA, fish oil, and other supplements.
I will watch for your talks when you return, so I might learn more in order to share with others.
[QUOTE=Maxime Zahra;192750]Dear Shandi,.../QUOTE]
06-26-2015, 09:18 AM
Jim Wilson
Re: Depressed? Try Therapy Without the Therapist
I would like to add a consideration to this intriguing thread -- sometimes it is reasonable to feel depressed. The culture seems to have adopted a position that depression is automatically a bad thing and that anytime anyone feels depressed intervention is called for. But, I think, there are times in life, in everyone's life, when depression is a completely natural and reasonable response to one's situation. The loss of a loved one is a good example. It is completely comprehensible, and I would argue, natural, for someone to feel depressed in such a situation. Recovery also happens naturally, but it happens at its own pace and it takes as long as it does. Talking to people, lingering over memories, comprehending the universality of loss, are antidotes to these feelings; but they take time. They are not like taking a pill but in the end they are more effective.
And there are other situations in life when depression is natural, comprehensible, and not a misguided response. If someone loses their job due to downsizing, then loses their significant other due to their own loss of income, and then their credit goes haywire, it is understandable that they feel depressed about it. Again, there are antidotes, and depression doesn't have to keep someone in that situation from moving forward (say, applying for another job). But my feeling is that making someone wrong because they are feeling depressed isn't helpful.
Feelings come and go; they change like the weather. Rainy days are just as important as those filled with sunshine. Similarly, the flow of feelings, the good feelings, the bad feelings, is natural. There are seasons of the mind and I think we need all of those seasons.
06-26-2015, 10:26 AM
Sara S
Re: Depressed? Try Therapy Without the Therapist
Absolutely, Jim; well put. If I weren't depressed after my son got killed, that would have been strange. I always thought that the bumper sticker that said "If You're Not Outraged, You"re Not Paying Attention" could also say "If You're Not Depressed, You're Not Paying Attention" and of course, they say that depression is stifled anger, or something like that.
Quote:
Posted in reply to the post by Jim Wilson:
I would like to add a consideration to this intriguing thread -...
06-26-2015, 12:36 PM
Shandi
Re: Depressed? Try Therapy Without the Therapist
Quote:
Posted in reply to the post by Jim Wilson:
I would like to add a consideration to this intriguing thread -...
Jim, I agree with all you've shared here.
I think we're moving away from identifying feelings as "good" or "bad", but our descriptions of things are very ingrained, and it would take a conscious effort to change. I like to remind myself to identify some things as "wanted" or "unwanted" rather than good or bad. It seems to change the dynamic, giving me more control or responsibility for these thoughts or feelings.
I've watched myself stumble and fall into the well of depression, and as you said, it's a normal response to a loss of control over circumstances whether it's loss of a loved one, a job, a home, or health. Mostly I think it's about loss of the ability to feel joy, which is understandable.
It affects every aspect of our lives, and can be the tipping point for the entire structure of one's life to fall apart. This is what has happened to the many homeless we see in our area. We can empathize with them, if we've ever experienced close calls that could have landed us in the same place. Losing a job, with children to feed, will stretch us in ways we never could have imagined. Following that loss, an inability to pay our debts can lead to a loss of home, and without family or friends to help out, we can easily end up on the street. This changes how we are seen and judged, which pushes us further down, until we see no options for changing our lives.
This can begin the thinking that contributes to suicidal despair. People who are in this state will probably not seek professional help, either online, or from a therapist. They are vulnerable to drugs that offer to help them feel better, and depending on what those drugs are, they can spiral down even further once the temporary high is over. I do think that cannabis offers the best mood shift available, but unfortunately it's not a real solution, just much better than drugs and alcohol.
The danger of depression lies in its duration and how seriously it impairs our ability to function, over that time period. I lived with a woman in Hawaii, who identified herself as chronically depressed. She spent most of her time alone, reading or walking in nature. She saw a psychiatrist weekly, who prescribed drugs that she took for years, without any improvement. They basically kept her from going over the edge. She hid her depression well, and I thought she was the most mentally healthy person I knew.
She visited me last year, and after not seeing her for 20 years, it was great to see that she had made progress in her life. She was volunteering at a senior center, writing, and making exquisite sculptures. She had lost her therapist when he moved, and she felt devastated for a time, but made an adjustment with a new person. She believes that she can't function without a therapist and the drugs, so this is her answer to chronic depression.
06-27-2015, 05:52 PM
gypsey
Re: Depressed? Try Therapy Without the Therapist
There is no one-size-fits-all treatment for depression, because there are different types of depression, Many of us experience situation depression brought on by loss for example such as death, divorce, job loss, etc,
In these cases, talk therapy, support groups, and brief periods where we use SRUI drugs could be most helpful, along with active participation in our wellness plan: physical activity, journaling, meditation, supplements...what works for us. The combination is something we can and should be in charge of.
However:
There are also very serious forms of depression that are due to brain chemistry. These may be most successfully treated with specific drugs, as well as some combination of natural supplements and other modalities including mind-body work, but require a careful diagnosis and plan developed with the person suffering and a trained professional team. (It's not a cookie cutter solution.)
There is no magic bullet, and I ask those of you who sometimes advertise on Wacco as if there was, to own this.
Thank you
06-27-2015, 05:58 PM
gypsey
Re: Depressed? Try Therapy Without the Therapist
Barry, you are right that CBT is a very helpful tool for folks suffering from situational depression. In my previous post of a few minutes ago, I shared the difference between the treatment we normal neurotics need and what someone suffering from a brain chemistry depression needs.
I see this as vitally important to understand. There are resources and links out there that also explain this difference if you wish to educate your audience.
Thanks,
Gypsey
Quote:
Posted in reply to the post by Barry:
CBT (Cognitive behavioral therapy) has been proven to be the most helpful treatment for depression (although Ketamine shows great promise). It's different than positive thinking. It's more like good hygiene for your thought process. When people are depressed they fall into several cognitive distortions such as "all or nothing thinking" and "overgeneralization". CBT offers a way for a depressed person to see the fallacy of their thinking. This is hugely helpful, because it's the destructive thought patterns that are often at the core of the depression.
CBT itself is fairly mechanical and simple once you get the hang of it. So much so, that the online program that the NY Times article refers to (MoodGym) can do it! But that's not to say there is no role for personal help as well. The article says that even non-trained personal assistance is very helpful, but I'm sure a trained person would be better. But still the program can be a big help and you don't have to wait till a week from tuesday to get started, nor pay it $100/hour!
