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Last Updated: Thursday, 5 April 2007, 11:36 GMT 12:36 UK
Can online therapy ease depression?
By Emma Wilkinson,
BBC News, health reporter

Computer keyboard
Computer-based therapy may help some patients with depression
The UK has a drastic shortage of therapists to treat people with depression, but what if patients could log on to a chat room to get the help they need?

Two NHS psychologists believe online therapy may be the answer to ridiculously long waiting lists which leave people little choice but to take antidepressants.

Economists have warned the UK needs 10,000 more therapists to treat the one in six adults suffering from depression or chronic anxiety and get people back to work.

The National Institute of Clinical and Health Excellence has also recommended cognitive behavioural therapy (CBT) as an alternative to medication.

But getting funding for, and training, thousands of therapists will take time and waiting lists for 'talking therapies' are currently months or even years long in some places.

Online CBT - which allows real-time therapy sessions from the comfort of the patient's home - may offer an alternative and is now being trialled in NHS patients.

Stress

Domini Thomas, aged 56, from Bristol was asked by her GP if she would like to take part in the trial after being signed off work with stress.

You learn how to cope with something that previously had seemed insurmountable
Domini Thomas

She said she had got to the point where she couldn't function.

"It was horrible, you just can't control your feelings and you don't know how to get out of this black hole you're in."

"The online CBT was absolutely brilliant, you learn how to cope with something that previously had seemed insurmountable."

She had 10 sessions of 55 minutes, where she would log on to the site at an agreed time and the therapist would talk her through tackling various problems.

"One thing she told me was to think of a photograph of something that makes you laugh and when you feel stress, you picture the photograph.

"You also have a saying that is personal to you, like a mantra, and that will bring you back from slipping backwards into depression."

After the course, Mrs Thomas was able to reduce the dose of antidepressants she was on and eventually come off them all together.

Access

Nadine Field and Sue Wright set up the Psychology Online service after realising patients were struggling to access therapy.

Sue Wright and Nadine Field
Sue Wright and Nadine Field offer therapy online

"We both work in the NHS and because of the case load and back log we thought there must be another way," explained Nadine.

"The lack of access means people are in a bad state when they get to treatment and then it takes longer."

Nadine and Sue have had several meetings with the Department of Health about offering the service on the NHS as, with the exception of those in the trial, individuals have to pay 60 per session.

Dr David Kessler, senior researcher at Bristol University and a part-time GP, is leading an online CBT trial which is being compared with standard GP care.

GPs generally feel that we have been told about how great CBT is but it still remains an elusive therapy
Dr David Kessler

"We know CBT works for all sorts of things, we also know there are some computerised CBT programmes, such as Beating the Blues that are also more useful than nothing.

"But this is more like being in a chat room with your therapist.

"It has a number of potential advantages - it would be great for housebound people, people who are very busy at work and find it difficult to get to CBT appointments.

"It also has the potential to be useful for people whose first language is not English and it's good for particular things such as agoraphobia.

"GPs generally feel that we have been told about how great CBT is but it still remains an elusive therapy.

"We're saying we need alternatives, patients want them and they're not available on the NHS."

Additional measure

The trial is due to report next year but the government recently announced that all health trusts should offer computerised CBT programmes for suitable patients.

Such approaches will not be suitable for everyone, as they require computer literacy, and some patients may be more comfortable meeting with a therapist in person.

Experts also warn computer-based therapy should not take the emphasis away from the need for investment in psychology services but should be an additional measure.

Mrs Thomas said she personally would have felt much more awkward having face-to-face therapy.

"It's so easy just to write down your thoughts."

"The online sessions got my confidence back almost without me realising it."


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