Therapy in Space
You haven’t seen your family for weeks. Your job performance is literally a matter of life and death. You’re cooped up in a small living space with work colleagues, and you can’t even step outside for a quick breath of fresh air. You’re an astronaut in space, and you’re depressed. Who can you turn to? The answer — a new computerised therapy system being developed for NASA — might turn out to be pretty useful right here on Earth, too.
Following successful beta tests using researchers in Antarctica, additional clinical evaluation of a new NASA-sponsored computerised depression treatment system is about to get underway. Developed by the National Space Biomedical Research Institute, the interactive multimedia software system will, according to a recent press release, “assist astronauts in recognizing and effectively managing depression and other psychosocial problems, which can pose a substantial threat to crew safety and mission operations during long-duration spaceflights”.
Project leader Dr James Cartreine, a research psychologist at Harvard Medical School, notes that the depression treatment module, part of a larger project called the Virtual Space Station, offers significant potential as a self-guided treatment resource for many people right here on Earth, not just for astronauts on space missions.
And Cartreine’s co-investigator, former astronaut Dr Jay Buckey, now a professor and physician at Dartmouth Medical School, suggests that the solution-focused approach of the depression module is both novel and based entirely upon proven methods: “These are unique NSBRI products that did not exist before,” he said. “The Virtual Space Station is based on proven treatment programs and is a very helpful way to work on problems in general.”
Of course, self-directed computerised depression treatment has been available for a long time, using a CBT model. Probably best known is Australia National University’s MoodGYM, while in the UK, struggling software company Ultrasis has long championed the use of Beating the Blues, their software system which has been approved by NICE (National Institute for Clinical Excellence) for use in the National Health Service.
This new contribution to the field from such a deep-pocketed sponsor as NASA promises both a new take on the idea of self-directed computer-mediated depression therapy and the potential for significantly wider — and probably free — access to the latest research-backed methods. (By contrast, even though MoodGYM provides computerised CBT for free, Ultrasis tries to sell individual consumers access to Beating the Blues for a whopping £300.)
As for astronauts in space, you might wonder: why not just rely on live communications with a psychologist or therapist over a radio link? As pointed out in a widely-reprinted Associated Press article this past weekend (here, for example), on a far-away mission to somewhere like Mars, where the distance to Earth could be as much as 250 million miles, it takes over 40 minutes for a radio signal to make the round trip. (22 minutes, 21 seconds each way, to be precise.) That makes the couple of seconds of delay we sometimes experience speaking by phone to people on the other side of the planet seem positively insignificant.
What about asynchronous online therapy via email with a real therapist, as opposed to synchronous therapy with a computer system? The press releases don’t mention the possibility, although my guess is that here, too, time plays an issue: if you’re feeling stressed or depressed right now about your colleague floating right on the other side of the bulkhead, it’s probably best not to have to wait until re-entry time to get that email reply back from your psychologist or therapist!
Editor’s Note: Dr Catreine formerly conducted research under the name James Carter, PhD.
Other articles by Dr Greg Mulhauser, Managing Editor
This article was last reviewed by Dr Greg Mulhauser, Managing Editor on Monday, 27th October 2008. You can leave a reply below.
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30th October 2008
Interesting Greg! I wonder what the programme actually looks like – I assume it is also a CBT model?
It also made me chuckle thinking that so many people with depression here on earth feel as if they are in outer space… this might be very appropriate!
4th November 2008
I appreciate your information and insight regarding internet therapy, especially since I see its potential to become more wide-spread with this funding and added attention. Even though you say it has been in existence for a while, it is not yet in the foreground; I believe it would be beneficial particularly for individuals who do not have the means to afford such mental help. Also, because there is a societal stigma attached to participating in therapy sessions, individuals could opt to handle these personal matters in a more inconspicuous fashion.
You quote Dr. Jay Buckley saying, “The Virtual Space Station is based on proven treatment programs and is a very helpful way to work on problems in general,” but how do you think internet-based therapy compares with face-to-face therapy? I understand that for astronauts this is the only option, but projecting into the future for the general public, do you think internet therapy would be a sufficient alternative? I believe it would depend on the nature of the disorder, but it seems that milder diagnoses could highly benefit from something like this that would promote reflection and self-evaluation.
I think you offer a valid point regarding asynchronous therapy via email. While it does have the time-delay, it seems like a healthy outlet for astronauts to discuss their mental concerns to an unbiased party. The emails could act as a diary for these space-explorers to anonymously record thoughts and feelings, which alone seems therapeutic. In their situation, it may be difficult to share issues with other crew members based on a fear of judgment or a perception of weakness, but in an email they would feel empowered to know that a psychologist is listening and will provide feedback. A problem might arise if an astronaut becomes frustrated and expects a quick-fix. The mental unrest that lies within an individual must also be coped with by that person alone; a psychologist just acts as a catalyst in this process.
4th November 2008
Hi Sarah and Emily,
Many thanks to you both for your comments!
@Sarah – I’ve only read about it from a third-person perspective, but from what I understand, it’s an entirely solution-focused approach.
@Emily – I think it’s important to distinguish between using a computer to mediate communication with a human therapist, on the one hand, and using a computer as a self-help tool (without a human directly available ‘on the other end’, so to speak), on the other. To my mind, both have an important and very useful — but distinctly different — role.
Computer software intended to be used primarily as a self-help tool (sometimes in conjunction with less frequent f2f meetings) has become pretty sophisticated, and CBT delivered by the likes of MoodGYM has done well in studies of effectiveness on depression, for example. Would you throw a person in an acute manic phase into a room with a computer-based CBT system and hope for the best? No, certainly not — but when used within the intended parameters, I think they’re actually doing pretty well.
As for computer-mediated communication, my own experience with providing online therapy services indicates that it can be effective for people presenting with a very wide range of problems — from basic personal development at the so-called ‘mild’ end all the way to those already diagnosed with one or more DSM Axis I disorders and even Axis II comorbidity. The essential point here, in my view, is that it is the therapeutic process that matters (and the ability of client and therapist to sustain that process) — not the details of the method of communication. Nobody asks, “hmmm, do you think therapy in Portuguese would be effective?” or “hey, can blind people ever have effective therapy (because after all, they can’t see their therapists)?”. For some reason, when you substitute in the word ‘internet’ or ‘computer’, it often throws the discussion into whole new directions with technology as the primary focus, rather than having the therapeutic process smack dab in the foreground.
Is it for everyone? Nope, clearly not! But then, neither is f2f therapy for everyone!
All the best,
Greg
10th November 2008
You make an important distinction between a human therapist using the internet as a means of communication and a software-self help tool. I especially like the example you use when you say, “can blind people ever have effective therapy?” That really made me think; of course the answer is yes, but I still think there is something about being in the presence of another human being that can afford a certain comfort feeling not present when speaking on the internet. I did not know that self-help software was so established, and that computer-mediated therapy can help mild to more severe disorders and comorbitity. Very interesting response, and this seems like a very promising method of therapy for the present and future!