A 13 May 2016 ScienceDaily article reports on a joint project between Universities of Liverpool and Manchester researchers on the use of a smartphone application to help people manage their problems. The report discusses the initial trial, noting “The ‘Catch It’ app uses some of the key principles of psychological approaches to mental health and well-being, and specifically Cognitive Behavioural Therapy (CBT). Helping users better understand their moods through use of an ongoing diary.”
The report is cautiously optimistic, concluding “Smartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted.”
Interestingly, some doubts about CBT have been aired recently. A 7 January 2016 article in The Guardian notes “Cheap and effective, CBT became the dominant form of therapy, consigning Freud to psychology’s dingy basement. But new studies have cast doubt on its supremacy – and shown dramatic results for psychoanalysis. Is it time to get back on the couch?” This article, Therapy wars: the revenge of Freud, attracted a lot of attention (766 comments) and comes with an “audio long read” version for readers who prefer to listen.
The Guardian article gives an interesting account of the emergence of Cognitive Behavioural Therapy (CBT) In the 1960s and 1970s as a practical, no frills alternative to Freudian psychoanalysis. There was empirical evidence that CBT was getting results, whereas the theoretical underpinning of Freudian methods had always been questioned and historical research was casting doubt on the facts behind some of Freud’s cases. Traditional psychoanalysts questioned whether CBT was oversimplifying complex psychological problems, treating the symptoms but ignoring the causes.
These reservations were largely ignored and CBT appeared to have won the day.
Until May 2015 that is, when a study by the UiT The Arctic University of Norway “seemed to show CBT getting less and less effective, as a treatment for depression, over time”. Then came the October 2015 results from London’s Tavistock clinic on “the first rigorous NHS study of long-term psychoanalysis as a treatment for chronic depression. For the most severely depressed, it concluded, 18 months of analysis worked far better…” Then an October 2015 report from the Swedish National Audit Office showed that “a multimillion pound scheme to reorient mental healthcare towards CBT had proved completely ineffective in meeting its goals.
The Guardian “long read” also considers neuroscience experiments which indicate that the brain processes information much faster than conscious awareness can keep track of it. The article quotes Louis Cozolino, writer of Why Therapy Works, “by the time we become consciously aware of an experience, it has already been processed many times, activated memories, and initiated complex patterns of behaviour.” This does seem to support the Freudian view of a complex relationship between the conscious and the subconscious. The article concludes that “Freud the man scaled heights of arrogance. But his legacy is a reminder that we shouldn’t necessarily expect life to be all that happy, nor to assume we can ever really know what’s going on inside – indeed, that we’re often deeply emotionally invested in preserving our ignorance of unsettling truths.”
So where does this leave us on the question of smartphone apps for CBT? The jury is still out on that. However, if users can better understand their moods through use of an ongoing diary, that may prompt them to consult a therapist of their choice.
The elephant in the room is whether mobile app development meets accepted standards of software quality – but that is a question for a future article.