I’m just back from the American Psychological Association’s 118th Convention in San Diego this year. It’s the annual gathering of the tribes, where the latest in psychological research, education, and practice is shared. As the saying goes, if it’s August, therapists cannot be found. But options for connecting to a source of support extend beyond the consultation room. There is a powerful role to be played by support groups, online as well as face-to-face, and numerous self-help tools now employ both online and offline components.
The presentation I attended the first day of the convention highlighted ongoing research and discussion ranging from support group participation to self-guided cognitive training in the Mood Gym, to positive psychology’s approach: “teaching happiness.”
We now have more than a decade of growing “evidence” for support groups’ efficacy – in this era where “evidence-based” is a mantra. Introduced by Dr. John Grohol, himself a pioneer in the promotion of online mental health resources, the first presenter was Dr. Azy Barak, widely known for maintaining and contributing to a vast bibliography of research involving Internet-based applications. He has both researched and developed numerous support groups, and has a particular interest in exploring the factors which contribute to positive outcomes for support group participants.
The two main mechanisms identified as key factors in positive experience among support group members are (1) the psychological effects of expressive writing [e.g., Pennebaker] and (2) group process dynamics, as classically described by Yalom. Some stages are fairly universal, while others may hold special appeal online, and bring both opportunities and challenges. Think: development of group cohesion, universality, ventilation, experience of mutual support, an atmosphere of advice giving & receiving, and shared learning.
Research to date has generally shown that participants tend to report satisfaction and relief, despite ongoing debates about proving “effectiveness” absolutely – the same efficacy vs. effectiveness discussion raging in f2f outcome research.
Dr. Barak and his colleagues conducted a series of 4 studies, targeting different populations (types/severity of distress) and using different methodology – the brief version being that some were part of an open-group environment, others closed, most using a forum format, free and anonymous. The study focused on identifying factors related to more positive ratings of the experience at “post-test” via self-ratings. In general the results indicate a significant relationship between level of participation (sending and receiving messages) and positive outcome. Questions at the end included one about contributing factors beyond participation level. In one word, Dr. Barak pointed to a big one: Motivation. Other speakers also spoke of “engagement” as a challenge.
Helen Christensen, Ph.D. described an automated CBT-based program deployed since 2001 and now used by 300,000 people world-wide: Mood Gym. It has shown positive results targeting anxiety, depression, and prevention. It is easily “scalable” and quite cost-effective after start-up. It is also part of a larger system which includes a portal for researchers and offers quite an extensive database. One study was conducted in Australia, in 30 schools across the country including Aboriginal areas. After 6 months of Mood Gym training, anxiety levels were significantly lower among both boys and girls, though only the boys experienced a significant drop in depression. Dr. Christensen emphasized how important she sees it to offer preventive tools, and of course this involves working with young people. There are some common barriers however, such as initial engagement, acceptance of the program as potentially helpful, adherence (staying with it rather than dropping out), and concern about online safety. Thus far continuation has been fairly strong, especially given the context that 70% of patients drop out of traditional f2f therapies.
Dr. Alicia Parks, former student of Martin Seligman (“positive psychology”) and researcher now at the U of P Positive Psychology Center, moves the notion of online help-seeking away from conventional “treatment.” She stated some reservations about CBT online and ventured that a more “positive” approach than treating symptoms is simply to “teach happiness.”
It needs to be said, as she did several times, the target population that they’ve been working with in a large study elicited by authentichappiness.org is those with “sub-clinical depressive symptoms”. This is a large group, for whom there is evidence that the “Positive Psychotherapy” (PP) program yields the benefit of a positive emotional experience and fosters resilience. Moreover, “it can counter depressive problems without having to label a disorder”. She sees this approach holding great potential, based on research, in terms of (1) effectiveness (2) motivation (improving “with learning through positive psychotherapy”); and (3) stigma – “People may be more willing to pursue happiness than seeking to fix a problem”.
The program involves a 6-week program consisting of completing 6 different exercises “targeting very different aspects of happiness”. It is done online, although as she pointed out, not fully automated. (Should it be? Would that impact “happiness”?) Food for thought.