The webpage for the Building a Meaningful LIfe through Behavior Activation on the CompTherapeutics website.
KALAMAZOO, MI — For people with depression, who have limited access to mental health care or who are worried about the stigma attached to seeking mental health services, a team of Western Michigan University researchers has a new online therapy alternative.
Using a therapy model called Behavioral Activation, they have created an online program called BAML, which is short for Building A Meaningful Life through Behavioral Activation and emphasizes changing action to change mood.
View full sizeRichard Spates
Richard Spates, a professor of psychology at WMU and a licensed clinical psychologist, is executive chairman and chief science officer of CompTherapeutics Inc., which operates BAML.
"Sitting in front on a computer isn't going to create change," Spates said. "Going out and doing activities is going to create change. Behavior Activation's central component is to break down the issue into small steps and help people stick with those steps.
"There is a relationship between our behavior and our moods. We take away the emphasis on thoughts on mood. We need to get people out of the notion that, 'I can lay in bed and think myself out of depression.'"
Many people who have seen therapy used for depression may be familiar with Cognitive Behavioral Therapy, a form of treatment based on an examination of thoughts, feelings and behaviors.
"The concept was natural at the time," he said. "The idea was that negative thinking is a part of depression. To change your depression you have to change your thinking, which will change your mood and build to changes in action. Research has show that is a faulty assumption."
In 1996, a study found Behavioral Activation, which is a part of CBT, was as effective as the entire course of CBT. In BA, it's believed as people become more depressed they avoid activities and become more isolated. The therapy encourages them to participate in activities that they enjoy and are related to their values and sets new routines for normal behaviors such as sleep and diet.
Behavioral Activation is as effective as CBT in about half the number of therapy sessions — eight versus 20 sessions, Spates said. "It was as effective in changing mood or thought without having to directly take five sessions to challenge a person's negative thinking."
The program is an interactive, video-rich online service, which guides users through a series of questions and lessons led by four actual therapists. In between the online "therapy" sessions, users are given homework assignments, which are built around users' concerns, such as sleeping or finding a job. Users can access the program for up to a year to complete booster lessons.
The program is up and running and being used at sites such as Rambling Road Pediatrics and the Southwest Michigan Department of Community Health, which includes sites such as Summit Point Community Health Agency in Battle Creek.
An online treatment option such as BAML can address a number of concerns that exist in the treatment of depression, such as the fact most patients are diagnosed by primary care physicians, and many patients resist further treatment through mental health facilities.
View full sizeDr. Bangalore Ramesh
Dr. Bangelore Ramesh, a psychiatrist with WMU and chief medical officer for CompTherapeutics, said primary care physicians prescribe 80 percent of antidepressants.
"As a psychiatrist, I see too many patients be put on antidepressants with no other form of treatment offered. This practice only helps some patients," Ramesh said. "In primary care, psychotherapy is rarely considered as an option. The large majority of patients also need psychotherapy to cope with stressors in their life.
"More importantly, relapses in depression can be best prevented by the patient learning methods to manage life better. This is the idea behind BAML. There are multiple studies showing that a combination of medication and therapy gives the best results when you look at remission rates in depression. "
It would also provide a therapy option to those who are resistant to or have difficulty seeking therapy at a mental health facility, Spates said. This could be especially true for professions such as the military, where seeking mental health services may be perceived as a weakness, or residents in nursing homes.
An online program allows patients to delve into therapy in the privacy of their homes — or anywhere they can find Internet access. The program constantly checks in with users to see if they've completed tasks and to check the level of their depression symptoms. If they become severely depressed or suicidal, the program directs them to a national suicide hotline. Also, for patients working with therapists, the therapists can monitor their progress through an administrative mode.
Studies have shown that computer therapies can be as effective as face-to-face therapy in some cases, Spates said. In addition, it provides more access for patients seeking alternative form of therapy.
"The comparison we have to keep in mind is that this isn't a comparison to perfection," Spates said. "BAML isn't going to improve all of the problems. But if 15 to 25 percent of patients didn't have to come back for treatment, if they found it easier to do online, then it solves a treatment problem for that amount of people. That's huge."
Linda S. Mah is a reporter for the Kalamazoo Gazette. Reach her at 269-303-6567 or her at lmah@mlive.com. You can follow her on Twitter.
Open all references in tabs: [1 - 6]