Inside Therapy: Getting Therapy on Your Smartphone

Tuesday, April 03, 2012

Archie Roberts, GoLocal Contributor

Is there really an app for that? Serious therapy is here for your smartphone.

According to the New York Times, you’ll soon be able to get therapy on your smartphone.

I’ve begun planning ahead. The therapy app will get pride of place between my text-messaging icon and my Facebook shortcut. By using it faithfully, I plan to improve my personality without the hassle of regular office visits to a shrink. There is a certain appeal to the idea of taming my demons from the comfort of my own home, especially if I can simultaneously anaesthetize them with a late night pint of Chubby Hubby.

The therapy app

But I shouldn’t make light of the therapy app. It uses technology developed at Harvard University in which video games are used in an attempt to re-train the nervous system. This piece of technological niftiness is based on a therapeutic approach called “Cognitive Bias Modification” (CBM), which purports to act on our "selective attention." Each of us, without realizing it, habitually attends to certain kinds of stimuli while ignoring others. Therapists have understood for decades that by helping our patients change the things they habitually pay attention to, we help them change their experience of the world. CBM takes the middle man out by providing a video game that changes the sorts of stimuli your brain pays attention to. So goes the theory.

Does the phone make it easier to get help?

A therapy like CBM—one that targets anxiety and can be delivered via smartphone—would appeal to many who might not otherwise seek help, and would free people from the significant burden and cost of traditional psychotherapy. That’s nothing to sneeze at. Traditional psychotherapy, after all, requires people to talk to actual therapists. For those of you who’ve never met one of us, you should know that, on the whole, we make for extraordinarily bland company. What’s worse from a public health standpoint: we make for extraordinarily expensive, bland company.

Because CBM offers a low-cost approach to therapy that can be easily delivered to millions of people in this country alone, it has won some deserved attention. And some funding. Early research has even suggested that it might be helpful in reducing a form of anxiety called social anxiety.

But will it prove effective? I have my doubts. Let me offer two reasons.

Drawback #1: How does anti-social tech help us socialize?

First let’s look at the case of “social anxiety,” the malady for which CBM purports to be particularly helpful. Social anxiety is also called social phobia in the mental health literature. Its sufferers are afraid of situations that bring them into contact with unfamiliar people, so they avoid those situations. In the long run, this attempt to avoid the anxiety evoked by other people actually sustains, deepens and prolongs the problem. The cure for most phobias involves safe, gradual exposure to that which is feared—so unless you’re trying to get over a fear of smartphones, I’m going to bet that the therapy app won’t help your social anxiety much. And if you’re already anxious in social situations, then lurking in the corner playing video games on your smartphone isn’t likely to help.

I would love to be wrong about this. By my guess is that this “promising new therapy that’s cheaper for everyone” will eventually be better known as a “once-promising therapy that earned a handful of people a whole lotta money.”

Which brings me to my second reason for suspecting the effectiveness of the therapy app.

Drawback #2: What master is really being served here?

Last I checked, the number of people who'd like to feel less anxious is hovering at around 6 billion. This makes CBM conspicuously well-positioned in the mental health market—a market whose bloated waistline I highlighted in my last column.

And there lies a real problem: the pernicious convergence of healthcare and industry. Therapy-via-smartphone places us squarely at the intersection of false promises and laissez-faire capitalism—and that’s an intersection where too many people get run down.

The driving force behind therapeutic innovations like the therapy app is a healthcare system in which entrepreneurs can make a killing by reducing public costs. Reducing cost is a worthwhile goal, but it’s not a clinical solution. Until we start rewarding the development of effective therapies, instead of low-cost therapies, we’ll keep getting what we pay for.

Still, I hold onto a sliver of hope about the therapy app. When you’re dealing with a phenomenon as complex, mysterious, and magnificent as a human being, you never know ahead of time what’s going to help. For some, a therapy app may actually prove more useful than a person.

It’s possible.

It's also possible that the Chubby Hubby in my freezer will eventually be shown to prevent the onset of Type II Diabetes.

Archie Roberts is a psychotherapist, professor, and writer. He's consulted to organizations around the world and makes his home in Providence. www.archieroberts.net