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Since its inception, the Internet has proven to be a useful tool.
From researching school projects to swapping recipes to making stock
market trades, people have found Web sites to help with virtually
all aspects of life. The World Wide Web has even found its way into
the realm of psychology, with online therapy and research programs,
with sites for mental health information and crisis intervention.
Funded in part by a small business grant from the National Institute
of Mental Health, a local company, MySelfHelp.com, has recently
begun to use the Internet to provide interactive, self-help programs
for mental illness. Confidential, subscription-based programs, they
are designed, says co-founder and president Richard C. Bedrosian,
Ph.D., to be an adjunct to traditional, face-to-face therapy. Based
on cognitive therapy, each program offers paid subscribers information
on specific disorders, exercises for changing behaviors and relapse
prevention techniques.
Bedrosian spoke with New England Psychologist's Catherine
Robertson Souter about his relatively new site (they went online
last summer after nearly six years of preparation) and plans for
its expansion.
Q: When did you start this company and why?
A: In 1997. The idea was triggered somewhat by limitations imposed
by managed care that made it increasingly hard to practice. I had
written a book with a cognitive therapy model about treating survivors
of childhood trauma. My original idea was to make that model into
a computer program. That was a very grandiose idea. It sort of slowly
got whittled down to reality.
Q: How has it changed?
A: First of all, what we are doing is more oriented towards
particular disorders with programs for many of the major mental
health problems. Secondly, we decided that we don't want to see
people doing a lot of trauma work online. We would rather see them
doing those face to face in therapy. But, we can have our programs
be informed by what we know about treating trauma survivors.
Ideally, we would like the person who uses our program to make
that part of their treatment, to share what they are doing with
their therapist and for the therapist to be aware of our programs
and direct people to parts that might be relevant.
We encourage people to share this information with their therapist.
When I was doing therapy, if I gave people an assignment to read
a self-help book, I would ask them to highlight areas that were
particularly helpful and then I'd go over it with them. That would
provide me with new information and new ways of looking at the client.
About 80 percent of the programs are interactive exercises. Right
now, we have three open to the public - Defeating Depression, Take
Control of Bulimia and Stop Binge Eating. We should have a fourth
by May on Hope for HIV and Depression.
Q: These are designed specifically for the patient to use at
home?
A: Yes. They log on to their own home page and use any one of
the programs. They can go through the programs page by page or they
can go directly to certain parts that are relevant to their particular
problems.
The programs are cognitive therapy oriented so people learn to
identify their thoughts and recognize distorted thinking. There
are questionnaires and exercises where they build towards some sort
of action plan. For instance, there is an exercise on relapse prevention
where they start by recognizing their early warning signs and then
identifying what to do about those warning signs.
Most of the exercises are meant to be used over and over again
so that people can extract the skills. It's meant to accompany therapy
so somebody could keep using the program indefinitely if they got
something out of it. Particularly in the areas where we are looking
at more long-term recovery issues, we really anticipate that people
are going to keep at those themes.
Q: I assume that this is all paid out of pocket?
A: Right now, it's out of pocket. We are in the midst of negotiating
with various insurance companies to see if they will subsidize some
of the subscription costs. We are also doing outcome studies to
get data that will indicate that by using our programs patients
will do better with their recovery. Then we will be able to negotiate
more effectively with health insurance.
Q: What does this offer that face-to-face therapy does not?
Or, what does it add?
A: First, it's available 24/7 so that people can use it during
symptomatic periods when they might not necessarily have access
to professional help. Like any self-help tool, it can provide people
with information over and above what a therapist can give in the
course of a one hour session. It also means that they get exposed
to certain opportunities to practice skills and repeat them. You
just can't do that in an hour of therapy.
We also have some downloadable visualization and relaxation audios
that they can access right on the site. We have different kinds
of ratings that people can do to follow the intensity or frequency
of their problems and they can keep track of that over time. We
have a program called First Aid Kits where people can save things
that really helped them and they can refer back to them.
The other thing that we are trying to do is to promote compliance
with medication and to educate people about psychotherapy so that
those who are not in treatment will investigate treatment and those
who are in treatment can overcome barriers they have to accepting
treatment.
Q: So far, how has the response been?
A: We have had tremendous response from clinicians. We've been
presenting at conferences and conventions and we've been connecting
with different professional networks, primarily online. Any clinician
can get a free pass use to our programs. We encourage people to
do that before recommending them to their clients. We find that
when people go on and actually use our programs, they are really
enthusiastic and they help their clients get the most out of it.
We have a few hundred subscribers already and we've only been around
for a couple of months. We haven't really been advertising.
Q: What does the future hold?
A: We have a very ambitious development schedule. We are developing
a couple of new products every quarter so that we will have about
18 different programs. We are going to be branching out into addiction
and anxiety disorders. We also have funding to launch a grief program
and that will be developed over the next few months.
With the exception of schizophrenia, we really want to cover as
many of the mental health diagnoses as possible. Plus, we are also
trying to provide resources on topics like guilt and shame, on grief,
on interpersonal conflicts - topic areas that cut across different
diagnoses so that the site can be a resource for people in treatment
regardless of what the presenting problems might be.
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