E-therapy moves in on shrink's couch

Internet therapy programs for depression and anxiety can be twice as effective as seeing a psychologist or psychiatrist in person, studies show.

A series of internet programmes delivered to more than 1000 people appears to have produced better results than gained by seeing a specialist at one of the country's best mental health clinics, and much better results than reported in the scientific literature.

''We're doing something unnerving,'' said Gavin Andrews, professor of psychiatry at the University of NSW, and the director of the Clinical Research Unit for Anxiety and Depression at St Vincent's Hospital. He joked about ''the end of psychiatry as we know it''.

The apparent success of the programmes poses fundamental questions for professionals for whom the patient-therapist relationship is considered integral to treatment.

Furthermore, with the Medicare bill for psychological treatment burgeoning, such low-cost therapy could deliver big savings and enable more people to obtain effective treatment.

The research unit has standardised online programs for treat- ing crippling shyness, depression, panic attacks and generalised anxiety disorder. The programs use cognitive behaviour therapy techniques.

An appealing animated character, who suffers the particular symptoms, leads people through the programs. There are six sessions over 10 weeks with added ''homework'', and clinicians require less than two hours with the patient.

Control trials, some reported in the Australian and New Zealand Journal of Psychiatry, illustrate the popularity and efficacy of the programs. People reported significant improvements in follow-up questionnaires soon after completing courses.

The results were twice as good as reported in the scientific literature for in-person therapy and ''about 25 per cent better than achieved at the St Vincent's anxiety disorders clinic'', Professor Andrews said.

The results from a six-month follow-up on two of the programs showed people had maintained their improved mental health. ''We're delivering something the punters love,'' he said.

The drop-out rate, of about 20 per cent, was much lower than the usual rate of about 50 per cent for face-to-face therapy. Email or telephone reminders to online patients to complete the next session were sometimes necessary.

The internet and clinic patients were given the same initial screening assessment - with care taken to identify the potentially suicidal. They had the same treatment content and outcome measurements.

Bob Montgomery, the president of the Australian Psychological Society, said it was ''way too early'' to dispense with therapists, and the research results would have to be replicated in other studies. He said young people and self-confident people could ''run with self-help programs'' but some people would still need support from a skilled therapist through an often uncomfortable process.

Professor Andrews admits to being flummoxed by the apparent success of ''e-therapy''. He said one in five Australians suffered a serious mental illness in any year but only a quarter of them received effective treatment.

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