The National Health Service (NHS) in the United Kingdom is a publicly funded healthcare system. In order to cope with the sheer numbers of people (adults) seeking mental health treatment and given the limitations of finances and time, they recommended this computer-based cognitive behaviour therapy (CBT) program for depression and anxiety. The 8 session, 50 minute per session “course” is recommended by physicians and psychiatrists. I had seen a presentation by Tony Attwood (famous for his work with Asperger’s), where he had used this for treatment with his clients. This is what piqued my interest in exploring this web-based “application” / program.
My (short) trial went like this: At first, I tried accessing the web based interface on my iPhone, but it did not look the same as it did on my computer. Once there, I took a mood checker assessment that gave me a depression and anxiety score with the advice that it has to be corroborated by a health professional. It encouraged me to make an appointment with a general practitioner or call the NHS. Naturally, this is not applicable to the Indian consumer. Next, three options were provided (1) for service providers (2) for patients like myself (3) for employers. I clicked on the option (2) which was immediately available. It cost £60 (approx. INR 6,500), and one can pay with PayPal. It claimed to have peer-reviewed publications and an evidence base. This is something that I have a personal issue with, because you can do research on whatever your government decides to fund. So, for instance, if the NHS decided to fund a program called “Eat Chocolate”, researchers would be paid to study it, and by the end of it we would have peer-reviewed literature on the efficacy and effectiveness of eating chocolate for mood (a personal favourite of mine). Nevertheless, publication is 100% better than no publication.
The sessions showed videos of actual (British) patients, with a voice-over from an expert clinician. It guided you through some basic concepts, the very same concepts that are taught to students in psychology colleges. Personally, I find the lack of inclusion of culture a grave omission. (But premier institutes in India, needs to come up with their own high quality material, in local languages). After a concept was taught in these videos, examples were given, model patients then demonstrated how to use the concept being discussed (which is more than what colleges do for psychology students). Several situations were completely irrelevant to the Indian scenario (for instance, a senior citizen in India does not have similar institutional support as someone in the UK).
Other cool stuff It was cool to see detailed case vignettes and how an application of frameworks and principles of CBT was shown. The focus being always on the “here and now.” There were videos that explained the cognitive model of emotions and interpretations of events. They demonstrated how to record thoughts and how to be aware of automatic thoughts. There was a lot of homework between sessions (something I did not do). At one point they also shifted focus to the behavioural therapy aspects of CBT. There was an explanation of thinking errors/ cognitive distortions. Behavioural experiments were highlighted. Deeper belief systems were targeted with an attempt to use the “downward arrow technique” (which I assume will be too much for some people to DIY i.e. do it yourself). There was an explanation of the negative biases that we might have with the suggestion to focus on the good stuff (sigh).
My concerns The applicability of this program to the Indian diaspora in the UK, but also to Indians in India is a true concern for me. Indian therapists should take note, because I suspect they use a similar model and indeed neglect cultural frameworks altogether. This isn’t surprising because afterall, this isn’t taught in college. A “One size fits all” therapy does not appeal to me, personally. I do however understand that some therapy is better than no therapy, especially when you need it but cannot afford it. Sitting in front of a computer, and being lectured loses the element of emotional resonance. [On a sidenote, Ultrasis Group Plc, the healthcare company that develops computerised healthcare products declared bankruptcy in 2015. It was bought by 365 Health and Wellbeing, a subsidiary of Hexagon care services.]
My Recommendations Ironically, I would recommend this to Indian teachers and students of psychology, who seldom have access to videos and demonstrations of techniques such as cognitive behaviour therapy (other than the free stuff found online).