Rorshack blogger Derek Boswell was featured on XR Blog.

Are Online Therapy Companies Capitalizing on Our Mental Health?

The increase in mental health awareness within the last few years is something we should be proud of. The awareness of the stigma and the boom of programs and services devoted to the prevention, management, and treatment of mental illness is truly a great feat. The representation of mental illness in big brands and in popular culture is a huge step forward in reducing the stigma associated with mental illness. However, someone is bound to try to capitalize on mental health simply because it's becoming popular with consumers. 

So, what does this look like? How do we tell when a company genuinely cares about our mental health, or whether they are only interested in our money? I plan to tackle these questions by focusing on internet-based therapy, a recent development in mental health that has made its way into popular culture. Brands like "BetterHelp" have been making waves on social media, with influencers both promoting and criticizing the claims made by these services. 

What Services Are Out There? 

The American Psychological Association (APA) lists some services on their website and gives a quick summary of the cost and what they offer. I've listed the most relevant companies below and attached links to their websites. You can visit this APA website for a comprehensive list of accredited services. 

1. BetterHelp: Offers online messaging, live phone and video chat ($35 USD/week). 
2. Breakthrough: Offers video conferencing (costs are determined by therapist). 
3. 7 Cups of Tea: Offers messaging ($37.50 USD/week or $150 USD/month). 
4. Talk Space: Offers text messaging, video and voice chat ($32 USD/week).

The APA acknowledges that there are benefits associated with these services, including that they could pave the way for accessing face-to-face therapy in the future. However, the APA also warns that both therapists and clients need to be cautious when it comes to internet-based therapy. This form of therapy could reduce the benefit of social interaction, and it also brings with it certain ethical issues. For example, these companies often have a lack of clear guidelines for handing high-risk situations such as a suicidal client. Another issue is that the majority of these companies are not created or run by psychologists, but rather individuals with a technology background. 

What Does Science Say?

With all of this in mind, I'm going to turn your attention to psychological science that speaks to the effectiveness of internet-based therapy, namely, Internet-Based Cognitive Behavioural Therapy (i-CBT). You may have heard of Cognitive Behavioural Therapy (CBT) because of it's wide-spread use. You may even have undergone CBT yourself. For those who are unfamiliar, the main goal of CBT is to change the patterns of thinking and behaviour that are behind dysfunctional emotions and psychological difficulties. The following study examined this therapeutic approach, but the researchers wanted to take a look at how effective it was when administered online rather than in-person. 

This 2018 article published in the Journal of Anxiety Disorders, uses a meta-analysis approach (examining an entire body of research on a given topic, and summarizing the results) to evaluate the effectiveness of i-CBT. The researchers looked at 107 studies that compared iCBT to a control group of individuals who were 18 years of age or older and diagnosed with a variety of psychological disorders (primarily anxiety and depressive disorders). Overall, this research demonstrates that "computerized therapy for anxiety and depressive disorders is effective, acceptable, and practical healthcare" (Andrews et al., 2018). In addition, the researchers also answered some other important questions regarding its effectiveness: 

Is It Harmful?: The results could not conclude whether there was any harm associated with i-CBT because there was no mention of harm or negative outcomes in any of the examined research. The researchers believe that future studies about the potential harms will be beneficial. 

Do People Stick To It?: Mostly. They found that 52-80% of participants adhered to i-CBT without dropping out. 

Are Clients Satisfied?: It seems like it. 61-100% of participants were satisfied with the programs. 

Is It Better Than Face-To-Face CBT?: This study found that there were no significant differences between i-CBT and CBT administered in person.

Are Therapists Committed?: They found that therapists spent almost 8x more time on face-to-face clients than i-CBT clients. 

In conclusion, it seems that internet-based therapy can be effective. But keep in mind, this research focuses on CBT as a therapeutic technique, not on internet therapy as a whole. It is also important to note that the researchers found no significant differences between internet-based and in-person CBT. This means that using internet-based therapy could be just as effective as seeing a therapist in person. Seeing a therapist in-person rather than through the internet is also a good way to ensure that your money will be going to an accredited practitioner, and not simply into the pocket of a technology company. 

I would like to end by reminding you that you have rights as a consumer of any form of therapy. Both the APA and CPA (Canadian Psychological Association) code of ethics outline the guidelines that accredited practitioners must follow. You have the right to know who is performing your therapy and what their qualifications are. This includes the degrees or diplomas they hold, and whether they are qualified to perform certain tasks regarding your treatment. You also have the right to know what form of therapy you will be undergoing (CBT or otherwise), what your role is in your own therapy, how long it will take, and the reason why it was chosen as a treatment.

References

Andrews, G., Basu, A., Cuijpers, P., Craske, M., Mcevoy, P., English, C., & Newby, J. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders,55, 70-78. doi:10.1016/j.janxdis.2018.01.001

Canadian Psychological Association. (2017). Retrieved November 6, 2018, from https://www.cpa.ca/aboutcpa/committees/ethics/codeofethics/

Ethical Principles of Psychologists and Code of Conduct. (2017). Retrieved November 6, 2018, from https://www.apa.org/ethics/code/

Novotney, A. (2017). A Growing Wave of Online Therapy. Retrieved November 6, 2018, from https://www.apa.org/monitor/2017/02/online-therapy.aspx

Sexual Assault policies in universities across North- America more harmful than useful?

The recent controversial appointment of the Supreme Court Judge who was alleged of sexual misconduct and assault during his time at University and high school has yet again put a spotlight on University policies regarding sexual assault on campus. The incident between Kavanaugh and Ramirez accused the former of assault at party which was held on campus at Yale’s Lawrence Hall. 

One of the first steps taken to prevent sexual assault on campus was in 2013 when the Congress in the Unites States passed the Violence Against Women Act(VAWA) which  required all federally funded universities to introduce mandatory policy against sexual violence and introduce intervention programs across campuses. Most of these intervention programs include bystander training and intervention. But the question arises - that are these programs actually effective, or are they indeed backfiring?

While researchers whose area of expertise is rape and rape culture believe that there is a need for intervention programs especially in males who are at higher risk of sexual aggression, there is plenty evidence that suggest that on the contrary, intervention programs make individuals who are at high risk more likely to engage in such activities after the Intervention program.

In a research study by Malamuth et al, (2018) recognizes that the key cause to failure of intervention programs or their ability to cause the opposite effect of what was actually intended through the intervention is that they generate “hostility reactance” which is one of the unintended adverse effects as of intervention programs as well as the cause of sexual violence. Such a boomerang effect has been seen in various mass communication campaigns which intend on changing anti-social behaviours. One potential explanation of this phenomenon is increase in the cognitive accessibility of attractive features of the activities for which the intervention programs are designed, which is especially prevalent in individuals who rate high in narcissistic behaviour particularly because they have a sense of entitlement.Those who have a narcissistic personality also tend to become more aggressive when faced with rejection which is the cause of . sexual violence itself. Moreover, the perceived “preaching” nature of the program which could potentially be viewed as a threat to their freedom of thought and action. As studies reviewed by this paper, boomerang effect is seen among 30 per cent of the individuals who are at high-risk of committing a sexual assault.

Moreover, the VAWA in no form states of allocates funds for the efficacy research of such programs. And the very little programs that are in fact evaluated, the evaluation itself has methodological issues. Hence it's surprising but no unusual to find that  not a single efficacy study of such intervention programs has pointed out the boomerang effect- an effect which is extremely crucial because it puts high risk individuals at in fact a greater risk because such programs are specifically designed for those who are at a particularly high risk of being sexually aggressive and not just the male population in general.  Thus the result of the rushed implementation programs involving intervention, and the inability to assess its efficacy has led to intervention programs that are ineffective and potentially more harmful.

Soon after the VAWA, in 2014 the provincial government of Ontario surveyed universities across Canada to investigate which universities had policy regarding sexual assault on campus and results revealed that only nine out of 78 universities had such a policy. Consequently, in 2016, the provincial government passed Bill 132- the Sexual Violence and Harassment Action Plan Act according to which, universities across Ontario had to implement policies on sexual assault on campus which had to come in to effect by January 2017.  Additionally, it required the institution to collect data and information about the prevalence of sexual assault on campus and to revise their policy every three years. The policies that have been put into place since, emphasize on prevention, education about consent, support as well as accountability for the survivor as well as the school community at large but does not have intervention programs.

 

Western University put into place it’s Sexual Violence Policy around the same time and 2018 marks the one -year mark of the implementation of the policy. Consequently, a Sexual Violence Review Team (SVRT) has also been put into place which is responsible for monitoring its efficacy and coordination of the University’s response to incidents involving Sexual Violence. Intervention programs were not introduced as they are potentially more harmful than good in high-risk male. 

To conclude, Sexual Assault policies involving intervention are more-harmful than those involving just training. There is a need to amend the VAWA such that it allots funds and mandatory studies to test the efficiency of the intervention programs in a scientifically methodological way, as well as the focus the policy of towards training, awareness and support rather than intervention

Malamuth, N. M., Huppin, M., & Linz, D. (2018). Sexual assault interventions may be doing more harm than good with high-risk males. Aggression and Violent Behavior,41, 20-24. doi:10.1016/j.avb.2018.05.010