Patients get addicted to their portable doctors

November 26, 1999

It is the ultimate therapist for the electronic era. The latest innovation in psychological treatment is the palmtop computer or electronic personal organiser, for which programs are now being developed to assess problems and administer therapy, writes Raj Persaud.

The first report of using palmtop computers to treat anxiety disorders, to be published in the journal Behaviour Modification by Michelle Newman of Pennsylvania State University and colleagues from Stanford University, found that portable electronic treatment was highly effective, even in severe cases of anxiety.

Previously, therapy was hamstrung by the problem of "retrospective recall bias", where patients have to recollect how they felt previously when recounting symptoms to a therapist. In contrast, the electronic organiser can record a rating or account of feelings at the precise time and location of symptom onset, so increasing the validity of the measure.

The reliability of the assessment also increases because the portable computer can make a series of measures and hence gain a larger sample size of behaviours.

In addition, it can administer treatment in the precise situation in which symptoms are experienced. Data gathered about symptoms can be downloaded directly into a flesh-and-blood therapist's computer, so increasing efficiency of recording data in patients' centralised records.

The first phase of treatment with the electronic organiser used in Dr Newman's study involved it beeping at regular intervals to prompt patients to record feelings and current precipitants of anxiety. The portable computer then provided feedback as to early causes of anxiety and gave relaxation advice when needed.

For example, it provided specific step-by-step instructions on slowing breathing and relaxing muscles. It then took another measure of anxiety to assess how things were developing and helped the patient decide whether they needed to continue with relaxation or could stop.

Another module of treatment in the portable computer administered cognitive behavioral therapy by prompting the patient to review the hard evidence for their worrying thoughts, and to identify common logical errors made in anxious thinking.

For example, the computer asks the client to rate how likely it is their greatest fear will come true, then questions whether there are other equally likely ways of viewing the situation. It subsequently puts questions like:

"Would you interpret this situation differently if you saw another person experiencing it?"

While the authors of the study emphasise the economic advantages of portable computer treatment over expensive therapist time, calculating a saving of over $1,000 per patient, perhaps the greatest benefit of portable computers administering treatment is the potential for unlimited treatment occasions.

But given that many of those who use electronic diaries could soon find themselves unable to run their lives without them, the potential for therapy addiction might be accentuated by this new form of treatment.

One patient in this study took the organiser on holiday, and another commented on how much they missed the computer on the day it crashed and was temporarily out of action.

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