Bad idea: Textual health

Isn't there something odd about offering people a "talking therapy" to help them address their problems, but then delivering it in ways that involve no talking at all?

Cognitive behavioural therapy (CBT), whose practitioners aim to train patients to avoid negative thoughts and actions, is the treatment of choice of the National Institute for Health and Clinical Excellence (NICE) for a variety of mental health problems, ranging from post-traumatic stress to bulimia. Perhaps unsurprisingly, this is usually done face to face.

But a recent Lancet seminar on eating disorders notes that research into CBT delivered via text message or online training programmes - also known as telemedicine - suggests that long-distance training may be helpful for bulimia patients and binge eaters, though the report includes the tentative caveat that "some uncertainty still remains".

NICE has already approved online programmes for depression and anxiety, yet it may be wise to be cautious. Not much research has been conducted to date, but what there is so far leans towards what common sense, that deeply unscientific system, would also suggest. Even CBT administered by telephone, which does involve some human contact, is less effective than face-to-face treatment, and interactive, internet-based CBT programmes have a higher dropout rate than other methods. Still, for those in need of treatment who can't or are too embarrassed to consult a therapist in person, long-distance CBT is better than nothing.

So the bad idea here is not actually the treatment, but what happens next. This being a cheap alternative, it may be that one-to-one CBT becomes less widely available to NHS patients. In which case this technological leap forward would be, as far as treatment goes, a big step back.

This article first appeared in the 30 November 2009 issue of the New Statesman, Left Hanging