Computerised anxiety therapy found helpful
By Catherine Walker
A new form of therapy which is known as cognitive bias modification (CBM) is emerging. CBM uses software to help patients divert attention away from anxiety and to interpret situations more calmly. In a pilot-scale randomised controlled trial it has been found to be helpful.
The clinical trial suggests that CBM may be about as effective as in-person therapy or drugs for treating social anxiety disorder. This form of treatment is a potential anxiety therapy that is delivered entirely on a computer.
The research also found that participants believed the therapy to be credible and acceptable.
The study is published in advance online in the journal Depression and Anxiety.
Participants in the pilot study improved their scores on a standardised measure of anxiety and on a public speaking task after completing two simple exercises twice a week for four weeks.
It is hoped that CBM can provide a new option for anxiety sufferers who cannot find or pay for qualified therapies or those who are afraid to try cognitive behavioural therapies. It would also prove useful for those who cannot or do not want to try medications.
The new study’s lead author, Courtney Beard, says that the idea of computer-based therapy has been controversial.
‘A lot of people are sceptical, particularly people like me who are clinicians and know how hard it is to help people with anxiety and how much effort and time it takes in therapy’ Beard said. ‘It just doesn’t seem possible that a computer programme could produce similar effects. But I’m more of a scientist than a clinician so I want to see data.’
Beard worked on the study with co-authors Risa Weisberg at Brown and Nader Amir at the University of California, San Diego. Beard’s study is the first randomised clinical trial albeit with a small sample size of 20 people who received the therapy and 12 placebo controls to combine two techniques of CBM to treat social anxiety disorder. The first technique seeks to enhance subjects’ control over what they pay attention to whilst the second trains them to interpret situations less anxiously.
The ‘attention’ technique trains subjects to ignore a worrying social cue and instead to complete a task. Subjects were quickly shown both a disgusted face and a neutral face on a split screen. One face would quickly be replaced with a letter, either an E or an F. The subjects’ task was to report which letter they saw. For those receiving the therapy, the neutral face was always the one replaced meaning the subjects had to divert their attention from the worrisome disgusted face. For the placebo group, either face had an equal chance of being replaced.
The interpretation technique encourages anxiety sufferers to assign benign interpretations to social situations. Subjects were asked to say whether a word they saw on the screen was related to the sentence that followed. Those receiving the therapy, for instance, would see either ‘embarrassing’ or ‘funny’ before seeing the sentence ‘People laugh after something you said.’ The subjects would be told they were correct if they chose the relatively benign word or incorrect if they chose the anxious interpretation. Placebo subjects, meanwhile, saw words that had nothing to do with the situation’s social nature.
Anxiety levels were reported by the participants five times during the four-week period. The level of anxiety for those receiving the therapy dropped considerably whilst for those in the placebo group it barely changed.
Beard said CBM still must be subjected to larger trials with longer follow-up times before the therapy's seeming effectiveness can be considered convincing.
Even then, she said, it's unlikely that CBM would displace other forms of treatment for anxiety disorders. Instead, it might prove worthwhile as a first step to try.
‘This certainly isn't going to replace therapy,’ she said. ‘I see it more as a very inexpensive, very easy to deliver, first-line intervention that could help a lot of people. For those it doesn't help, then maybe we could devote the more expensive and time-intensive resources to them.’
