Who needs to trek to weekly appointments when you can “see” a therapist online? Ginny Graves tries out the new craze for digital counseling.
It’s 2:56 a.m., and I’m sitting in my bedroom armchair, listening to my husband’s steady breathing and gazing at my side of our extralong queen bed. It looks so inviting in the moonlight, with its tousled duvet. But I can’t crawl back in. Raphael Rose, Ph.D., the psychologist who has been working with me on my chronic anxiety, would forbid it. Just yesterday he said, “If you can’t sleep, get out of bed—and don’t go back in till you feel tired.” I wish I could ask Rose to consider making an exception, but he and I aren’t in the habit of discussing my problems. We’ve never even met. He’s the shrink in SMART-OP, a cutting-edge computerized program I’ve signed on for.
I saw an in-the-flesh therapist last year. Alice. She had a spot-on sense for when to probe and when to pass the tissues. I adored her. But I am perennially juggling numerous assignments, and committing to a regular weekly appointment is nearly impossible. That’s the reason I quit seeing her, and Stefan a few years ago, and Diane some years before that. So when I read about the surge in digital therapy—every session just a security code away—I figured, why not?
In the U.K. the approach has been adopted by tens of thousands of people; now it’s gaining a foothold in the U.S. “Busy women who don’t have time to squeeze in a weekly appointment with a therapist are particularly interested,” says Kathleen Carroll, Ph.D., the Albert E. Kent professor of psychiatry at Yale University School of Medicine. “It’s an obvious choice for digital natives,” says Kate Ryder, 33, who launched Maven, which puts an Uber spin on mental health. The app charges $70 for a 40-minute video chat with a qualified psychologist or a psychiatric nurse practitioner authorized to prescribe medication.
Until recently, the office visit was sacrosanct. Technology entered the picture only if you had to make an emergency call to your shrink when she was vacationing on Cape Cod. Now even some old-school therapists see patients by video. Though the American Psychological Association has voiced privacy concerns, “I like Skype appointments because they allow me to see a more relaxed side of my patients,” says Dora Attermann, M.D., a psychiatrist in Larchmont, New York.
No one who is seriously mentally ill or suicidal should attempt to replace her therapist with an avatar or a spot of FaceTime, cautions Renée Binder, M.D., president of the American Psychiatric Association. But for high-functioning types afflicted with mild depression, insomnia, or—as in my case—anxiety, computer-based therapy can be constructive. After considering options including mood-tracking app Moodnotes, and Talkspace, an app that offers on-demand therapy in a video chat or text, I came across what looked like a promising fit on the UCLA Anxiety and Depression Research Center’s site. SMART-OP stands for Stress Management and Resilience Training for Optimal Performance. Currently, it is being put to the test by a mission-control crew at the NASA Johnson Space Center—the team responsible for shepherding astronauts safely through the outer realms. (If stress were an Olympic event, they’d be going for the gold.)
SMART-OP utilizes cognitive behavioral therapy, or CBT, an action-based approach that helps patients identify unproductive thinking and change behavior. The program’s to-the-point-ness appealed to me, as did the absence of live conversation, which can sometimes move in endless circles.
So I emailed Rose, SMART-OP’s designer and star of its recorded segments. The roughly 45-minute sessions, which play out on a computer screen, alternate between short prerecorded videos of him explaining coping strategies, and interactive, game-style segments. In one of those, questions pop up on-screen and the user types in answers, which are played back throughout subsequent sessions in the interest of helping her to stay on track. Rose told me the program was not on the market. Helpfully, though, he agreed to let me try it out.
I wear my pajamas to my first “appointment” at eleven at night and press play on the computer. There on the screen, perched on a stool in front of a chalkboard, Rose looks like a college professor, right down to his wire-frame glasses. “Stress is part of living,” he assures me in an affable tone. “We can’t avoid it, but we can learn to manage it.”
Then comes the first of several interactive segments, where I’m prompted to type in my particular issues as well as ideas for remedies. I identify my anxiety triggers—from a heavy workload to worries about aging—and begin to see how my jittery internal monologue (That mole looks suspicious. . . . Why did I give in to the pain au chocolat at breakfast?) and questionable coping mechanisms (the extra glass of pinot noir, the procrastination) compound my woes.
Rose guides me in a strategy that is designed to help me redirect my attention away from unhealthy responses to stress. I acknowledge a stressful thought—Are those new wrinkles between my eyes?—then attempt to put it aside by turning my attention to a parade of multiple-choice questions that flash rapidly on the screen. What is 97 minus 42? What country is bordered only by Spain? What is the largest planet in our solar system? I’m allotted just a few seconds per question, so I click on answers as quickly as I can. My performance is abysmal, though I’m not certain it’s due to my undisciplined mind so much as to my math and geography skills.
Over the following week, I strive to subdue my stress with the program’s science-vetted strategies. When I find myself Googling “dermabrasion” during the workday, I tell myself to set aside my skin concerns till I’m done with my work. Another day, when a chatty friend calls at a hectic moment and launches into a story about an antagonistic run-in she just had at the Pilates studio, I consciously keep my breathing smooth and even, just as Rose has instructed. And after a few nights of trying it, I discover that using progressive muscle relaxation before sleep—clenching, in turn, my legs, abs, arms, and shoulders as tightly as I can for ten seconds at a time—is almost as effective at dissolving tension as the green-and-white benzodiazepine capsules I’ve been relying on more and more of late.
I’m learning to look at my worries and fears and “test them for accuracy,” as Rose recommends. Did my friend Susan leave my call unreturned because she’s angry at me? Is my forgetfulness a sign of early dementia? By jotting down evidence for and against such worst-case thoughts, per Rose’s recommendation, I see how I script much of my own drama.
Before starting SMART-OP, I wondered if the absence of real-life interaction would present a problem. But I’ve developed an affinity for Raph, as I now call him. I like the thought-provoking nature of the exercises he provides, and the reassuring way he brings his fingertips together, steeple-style, at the end of a sentence.
I don’t miss the meaningful feedback of real-person interaction until true difficulty strikes. Five sessions in, my 20-year-old son calls to inform my husband and me that he’s decided to abandon his spot in a well-respected film school and enlist in the Marines. He is an arty, sensitive kid, and I can’t imagine him holding a gun, much less firing one. I try progressively relaxing and stream-of-consciousness writing about my anguish, as Raph has instructed. It provides a degree of solace. Yet I still lie wide-eyed in the middle of the night.
Desperate, I call my former therapist. Alice tells me she has time to see me right away. During our session, she doesn’t offer advice or strategies so much as sympathy and support—comforting but short-lived. By evening I’m as worried as ever. I boot up my computer and tackle my final session of SMART-OP. As I review Raph’s rules for effective communication (use “I” statements; ask questions instead of jumping to conclusions) and brainstorm an action plan for talking to my son, I see how deeply valuable these skills can be. They cut through the clutter of a panic-logged brain and illuminate a possible path forward.
Although I’m sure I’ll see Alice again, Raph had actually come to the rescue in unexpected ways. His pragmatic MO is better suited to how I live now—protective of my time, enmeshed with technology. A few months after I first “met” Raph, my anxiety has significantly dropped, and after no small amount of negotiations, my son has agreed to focus on photography and consider his options before enlisting. I’m done with dredging up the past on a couch—at least on a couch that isn’t my own.
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