Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
Article Type: Internet review From: Health Education, Volume 108, Issue 4.
As a tool for educational purposes, the Internet is now well established but as a means of therapeutic intervention it is still early days. The National Institute for Health and Clinical Excellence (NICE), has recognised that in some circumstances, online clinical interventions may be useful in the treatment of anxiety and depression. These interventions are using what is in effect an online version of cognitive behaviour therapy (CBT) that has long been recognised as one of the most effective forms of treatment for this type of disorder. CBT often has an educational element as a core part of the technique so it should not be surprising that it lends itself to online prescription. Along with other forms of behaviour modification techniques, CBT is also used in the treatment of phobias, and the question being posed in this review deals with the efficacy of online interventions for the treatment of phobias. Online interventions differ in terms of their accessibility. Some have to be paid for, others are only available via the National Health Service after being prescribed by a doctor. In this review we will only look at web sites that make their resources freely available.
The National Phobics Society
Started some 30 years ago by an agoraphobic this charitable organisation is still run by “sufferers and ex-sufferers”, though it is now also supported by a medical advisory panel. The web site has an attractively designed home page with a good balance of information and services. An online shop is available through which users can purchase a variety of books and audiotapes; members of the Society can get a discount on these products. Under the “Services” section of the web site members can gain access to a variety of helpful resources to assist in coping with their particular phobia. These services include 1:1 therapy offering CBT, hypnotherapy, counselling and complementary therapies. There is also an anxiety phone-in service where users can discuss their own problems with people who have themselves suffered from similar difficulties. There is also and a member’s helpline manned by experienced volunteers. For many users of this web site, arguably the most important section will be that providing “Information, support and advice”.
As would be expected the “Information, support and advice” section begins by listing some of the better known phobias starting with agoraphobia and ending with toilet phobia. For each listed phobia information is provided that explains what the condition is and what sorts of problems it creates for sufferers. There is a DIY self-diagnosis kit that amounts to a few questions about a person’s behaviour in the previous six months. Answering yes to most of these questions is a good indication that you might be affected by the condition. Following this the user is provided with recommended reading including links to a number of web sites. There is also a section on “Personal experiences” that users may find of interest.
Under the section on “Treatment and therapy” users of this web site will find information on the drugs used to treat anxiety disorders with a pharmaceutical and herbal treatment guide. There is information on “Talking therapies” as well “UK therapy locations”. “Computer aided therapies” are also included and the link gives access to a good review of the types of therapies that fall under this banner. Computer Aided Cognitive Behavioural Therapy (CCBT) is given a good review and access to the NICE report on these therapies is available (www.nice.org.uk/guidance/index.jsp?action=byID&o=11568). Perhaps the most interesting part of this web site is the attempt to provide online treatment through the “Waysforward” link. Waysforward is a self-help programme that provides “Solution focused” support, and what’s more it is free! The Waysforward programme (www.waysforward.com/) presents the user with a colourful interface through which they interact with their “therapist”. Answering questions about your problem and what it would be like to be free of the problem takes the user through the stages that would typically be used by a real therapist. It reminded me of the early online Rogerian therapists like Eliza (www-ai.ijs.si/eliza/eliza.html) though Waysforward does achieve rather more than Eliza ever did! One session with this programme will not be enough to help most people overcome their phobias, but with repeated sessions you can see how it might help.
The National Phobics Society web site is a really good resource, not just for people trying to cope with a debilitating condition, but also for their family and friends who might want to learn more about the problem. It is early days yet for the Waysforward programme, but it certainly appears to have great potential.
Phobias online sounds like it might be the web site that offers online treatment for phobias, but this would only be partly true. Any treatment for phobias must involve an element of education and in this the web site is partly successful. Without going into a great deal of detail about different types of phobia the web site offers advice and guidance on self-treatment. Various strategies are suggested including visualisation techniques and coping skills which although simplistic, e.g. “Take action” or “Talk to someone”, could form the basis of a self-treatment plan. There is also a brief section on medications that can be used in the treatment of phobias.
The sections on “Causes and treatment” are rather simplistic but that may not be a bad thing for some users. This is not a web site for academics nor health education professionals, but it does have something to offer a person who is suffering from a mild phobia.
Unfortunately it needs better maintenance, many of the links don’t work. It also appears to be funded by advertising and it has to be said that at times the advertisements get in the way of the content.
Dental Fear Central
This web site deals with the specific condition of dental phobia though much of the online materials available would be suitable for the treatment of other types of phobia. Most users will probably start off with a look at the “Common fears” section. Here the user will find explanations for some of the most common dental phobias and fears as well as tips on how to cope with these fears. As well as the usual fears to do with pain, the sound of the drill and so on, there are also sections on “Embarrassment”, “Loss of control”, even fears to do with the cost of treatment are dealt with. A number of downloadable resources are available including worksheets that are designed to help people understand and come to terms with their fears.
The section on “Help” is very comprehensive as well as being practical. Here the user will find advice on how to find the right dentist for them; there are even sample letters that the user can give to their dentist to help explain their problems. Psychological methods that aid coping are discussed and the user can download a “stressbuster” mp3 recording that is basically a five-minute relaxation session. Users of this web site, patients and dentists, can email advice on coping with dental phobia to a “Tips and tricks” section and at the time of writing this appeared to be well subscribed.
For a dental phobic the section on “Dentistry for dummies” may be going just a little too far! In this section the first thing the user will come across is DIY Dentistry and Prevention. Despite the title it is not really about self-extraction of molars; what it presents is good advice on how to look after your teeth so you won’t need to go to the dentist. For those who insist on going down the DIY route, the web site provides a comprehensive review of dental repair kits that are available commercially and can be used by amateurs.
The “Resources” section of this web site is very good with links to a considerable number of other web sites dealing with dental phobia. Their are also links to related web sites dealing with other types of phobia, panic attacks and anxiety in general.
The content, design and implementation of this web site are all good if a little amateurish. Images that don’t appear and links from the web page you are looking at that return you to the same page, do detract from what could be an excellent online resource.
Triumph over Phobia
This web site represents an interesting contrast to the previous sites reviewed. The main aim of this web site is to provide a national network of self-help groups to help people with phobia problems and obsessive-compulsive disorders (OCD). Although there is a small amount of information about these two conditions available from this web site there is very little content on different forms of treatment. What the web site does is provide a gateway into a number of self-help groups spread all over he UK.
One of the more original features of this web site is found under the heading of “Research projects”. The user will not find reports of research projects here; rather they will find a list of research projects looking at various aspects of phobia and OCD that are seeking the help of volunteer participants. This is an interesting way to recruit participants for research studies and perhaps something that other web sites should also consider.
On its own, Triumph over Phobia, is not a web site that will help people cope with their phobias. However by providing links to a self-help network, it may indeed achieve that aim.