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The Therapist May See You Anytime, Anywhere
By Benedict Carey
The very idea of psychotherapy seems to defy the instant-access, video screen chatter of popular digital culture.
Not for long, if some scientists have their way. In the past few years researchers have been testing simple video-game-like programs aimed at relieving common problems like anxiety and depression. These recent resultshave been encouraging enough that investigators are now delivering the programs on smartphones — therapy apps, in effect, that may soon make psychological help accessible anytime, anywhere, whether in the grocery store line, on the bus or just before a work 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 arebuilt 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 intraditional 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.”
Thesmartphone study is only one of the most recent tests of an approach called cognitive bias modification, or C.B.M., that seeks to break some of the brain’s bad habits. The premise, pioneered by Colin MacLeod of the University of Western Australia, is straightforward. Consider people with social anxiety, a kind of extreme shyness that can leave people breathless with dread. Studies have found thatmany who struggle with such anxiety fixate subconsciously on hostile faces in a crowd of people with mostly relaxed expressions, as if they see only the bad apples in a bushel of mostly 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, forinstance, 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 screenthat 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 DiegoState 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...