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Technology is transformative. Twenty-five years ago most of us couldn’t have imagined the convenience that computers, the internet, or cell phones have brought us. Twenty-five years from now, it might be hard to imagine a time when we drove our own cars, heated our homes with fossil fuels, or went to see a human therapist.
Because therapies like CBT are based on learning principles and involve imparting discrete knowledge and skills, they lend themselves to delivery via the computer, and so it’s no wonder that psychologists have attempted to do just that over the past 20 years or so. But these efforts have resulted in almost no change in how therapy delivered. It is striking to consider how little impact computers and technology have on the treatment of psychological problems like anxiety or depression. Juxtapose that situation with the degree to which technology has been implemented in any other industry and it feels like psychologists are toiling away in the dark ages.
So why is tech-driven therapy lagging? An obvious reason is that most people believe that the process of therapy is too complex for a computer to effectively simulate. Effective therapists are believed to account for a complex array of variables that likely involves scores of factors that are unique to each patient. Currently, technology can deliver therapeutic content, and some programs offer interactive features, but we are a long way from the complex interplay that often occurs in therapy.
Will therapists go the way of switchboard operators, video store owners, and ice delivery services? Can technology make therapists obsolete? I think technology can and should replace therapists. Technologies will progress to allow us to manage the complex interplay we call therapy. This would include subtle components of treatment involving understanding emotion, motivation, and compliance.
Much of the work we do in our lab now involves the use of technology to deliver therapeutic interventions. Many of these interventions are very brief, less than an hour, and can be delivered on a phone or through a website (Norr, Gibby & Schmidt, 2017; Schmidt, Capron, Raines & Allan, 2014; Schmidt, Norr, Allan, Raines & Capron, 2017). This kind of “therapy” might not look exactly like the kind of treatment you receive in a typical clinic, but these brief interventions produce significant and lasting changes that impact important outcomes like anxiety, PTSD and suicide (Boffa & Schmidt, 2019; Short et al., 2017; Timpano, Raines, Shaw, Keough, & Schmidt, 2016).
This is the beginning stage of tech-driven therapy. Now fairly structured interventions can be readily simulated. It is only a matter of time and ingenuity before programming allows us to capture and simulate the more complex elements of therapy. Take a lesson from the IBM Deep Blue program, where a supercomputer was used to play chess. A little over 20 years ago, Deep Blue was able to defeat the reigning world chess champion in a series of matches. During the match, Garry Kasparov protested that IBM was somehow cheating by having a chess grandmaster control the computer moves. He was convinced of this because the play was “too human” to be generated by a computer program. In other words, technology had evolved sufficiently to mimic a chess grandmaster.
It’s interesting to consider whether the interplay in therapy might be more or less complex than the that in an elite level chess match. Can we create a program to “beat” the best therapists—Deep Gray (as in gray matter)? I think it can and should be done, but not without a great deal of effort and money. Imagine the time and resources it took IBM to develop Deep Blue. I challenge companies and foundations such as the Bill and Melinda Gates Foundation to turn their attention to this issue. With this sort of backing, we could radically evolve the delivery of mental health services. Most people suffering from mental illnesses do not receive treatment or receive suboptimal treatment. Tech offers the opportunity to substantially impact human suffering by creating effective therapies that could be disseminated to anyone with access to the internet.
References
Boffa, J. W., & Schmidt, N. B. (2019). Reductions in anxiety sensitivity cognitive concerns prospectively mitigate trauma symptom development. Behaviour research and therapy, 113, 39-47.
Norr, A. M., Gibby, B. A., & Schmidt, N. B. (2017). Is computerized psychoeducation sufficient to reduce anxiety sensitivity in an at-risk sample?: A randomized trial. Journal of affective disorders, 212, 48-55.
Schmidt, N. B., Capron, D. W., Raines, A. M., & Allan, N. P. (2014). Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns. Journal of consulting and clinical psychology, 82(6), 1023.
Schmidt, N. B., Norr, A. M., Allan, N. P., Raines, A. M., & Capron, D. W. (2017). A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation. Journal of consulting and clinical psychology, 85(6), 596.
Short, N. A., Boffa, J. W., King, S., Albanese, B. J., Allan, N. P., & Schmidt, N. B. (2017). A randomized clinical trial examining the effects of an anxiety sensitivity intervention on insomnia symptoms: Replication and extension. Behaviour research and therapy, 99, 108-116.
Timpano, K. R., Raines, A. M., Shaw, A. M., Keough, M. E., & Schmidt, N. B. (2016). Effects of a brief anxiety sensitivity reduction intervention on obsessive compulsive spectrum symptoms in a young adult sample. Journal of psychiatric research, 83, 8-15.
