The Internet is celebrated and castigated in equal measure -- but is it good for your mental health?

Are you compelled to check your email morning, night and day?

Some believe Internet Addiction Disorder is a very real and growing concern.

Others aren't at all convinced it exists.

Also, the rise of psychological therapies online -- from depression to social phobia or bulimia -- can a computer really replace your therapist?

Transcript

Robotic voice: Welcome to All in the Mind on ABC Radio National, your host has been hijacked by a computer.

Natasha Mitchell: No she hasn't, Natasha Mitchell here after all. Now, Fearfighter, Beating the Blues -- computer games with a mental health edge, or self-help titles at your local book shop?

Well, you'll find them via your computer but these are no games.

On the show today from the prospect of internet addiction disorder to the rise of psychological therapies online or even by text message -- what are the implications for your mental health? Do you compulsively check your email multiple times a day or take a peek at your Facebook page perhaps? Some suggest 10% of online users have Internet Addiction Disorder and it's an affliction on the rise.

Psychologist Dr Vaughan Bell from the Institute of Psychiatry at Kings College London is deeply sceptical. He writes for the popular blog called Mind Hacks.

Vaughan Bell: Addiction is something that seems to be quite a popular label at the moment, we like to think of things in terms of addiction because it seems very medical, it seems like a disorder, it seems it's not the person's fault. Whereas I think it's being used in quite inappropriate ways sometimes and actually misguides us as to what the general problem is.

Natasha Mitchell: That said though there are a number of clinics around the world now, I mean MacLean Hospital at Harvard University has a computer addiction clinic. What do you make of that?

Vaughan Bell: I'm really quite sceptical and I suspect a lot of their work is actually people who turn up who use the internet a great deal. And I suspect a lot of their work is actually dealing with people with kind of social anxiety and depression and so on. In fact some of the best work on problematic internet use is by a guy called Scott Kaplan at the University of Delaware and he actually conceptualises it in really quite a different way.

He talks about it in terms of people with social difficulties or social anxiety who just use the internet because it's a way of managing those difficulties. And he's developed very specific CBT treatments of models based on quite sound research evidence that actually target people's social anxiety and social skills rather than considering people to be addicted to something, as if they were addicted to gambling or addicted to drugs.

Natasha Mitchell: The irony in all this is that the internet is now also a vehicle to deliver psychological therapies to many of these groups. What do you think of that rise, the rise of computerised cognitive behavioural therapy programs and that sort of thing?

Vaughan Bell: I think it's quite a positive thing, I mean web based cognitive behavioural therapy may not be for everybody but it certainly seems to be quite effective for people who do take part in it. And in fact there are quite fantastic online services, in fact one of the best is an Australian service called Moodgym and it's been shown to -- both in people who just randomly turn up to it and people who have been deliberately referred to it -- to be really quite effective in combating depression.

And what this shows us is actually some of these evidence based techniques we've used and developed for actually helping people with depression can be applied quite well to the internet.

Natasha Mitchell: And more from Dr Vaughan Bell on internet addiction later. You've heard of cognitive behavioural therapy or CBT on the show before, it targets unhelpful thoughts and behaviours. But what about CCBT? Computerised cognitive behavioural therapy. Are computers poised to take over the role of flesh and blood psychologists? And are they really up to the tricky task of mediating over our mental health?

Nick Titov: We've been doing this for many years and we are using technology and computers in lots of different interesting ways in mental health.

Natasha Mitchell: Psychologist Dr Nick Titov is from the School of Psychiatry at the University of New South Wales.

Nick Titov: People will use technology in as many different ways as they can think of; probably no different to our early experiences with radio or television -- many people were very concerned about the social implications and the consequences for public health of introducing radio and television and other technologies.

And we are certainly at that point with computers and the internet.

The reality is computers and the internet aren't going to go away so let's use them to improve the health and well being of people and to support the treatment of mental illness.

Now one of the encouraging things about the computerised CBT programs is that they appear to be very effective for the common mental disorders which include depression and some of the anxiety disorders.

Also for panic disorder and agoraphobia, that is conditions where people are concerned about panic attacks and as a consequence are fearful about leaving their home environment.

Anita Barraud: Couldn't that be counter-productive though, especially dealing with agoraphobia, fear of the outside?

Nick Titov: Look I can see why people would think that, but they have to complete lessons on weekly or bi-weekly basis online but then they're asked to complete homework assignments and those homework assignments are an opportunity to review what they've been learning but also to learn and practise new techniques which will help them gain mastery over their symptoms.

So the actual practice of the techniques, much as it would be with face to face therapy, involves people going out and practising in their natural environments which might be their workplace, it might be at the educational institute where they're at, it might be in their community with family and friends and so on.

Natasha Mitchell: Nick Titov and colleagues are trialling a pilot program online called Shyness TV, All In The Mind's Anita Barraud is logging on to check it out.

Anita Barraud: OK Nick, I'm just going to log on to it, go, and...OK so I've logged on to Shyness TV which I understand is a pilot program you're developing.

Nick Titov: Yeah that's right, it's the first time that social phobia has been treated online in Australia and the aim of the program really is to help us determine whether we can successfully treat people with social phobia online.

Anita Barraud: And when you go to the website there's quite a comprehensive list of parameters, rules of engagement, if you like, such as you must not have a psychiatric disorder like bipolar...

Nick Titov: Because really we want to make sure the people who apply for the program will benefit from it. But when people have logged on and completed their application and we've telephoned them to confirm the diagnosis and answered their questions of course, people then get access to the program.

Anita Barraud: OK, well I'm going to, having filled in the questionnaire and so on, I'm going to lesson 1, it has a course introduction and I'm just about to start...

Natasha Mitchell: One man who's exploiting technology to deliver psychological therapies for decades is Emeritus Professor Dr Isaac Marks from King's College, London. He's one of the founding fathers of computerised cognitive behavioural therapies.

Isaac Marks: The fact that we had effective treatments but too few therapists to help the many people who could benefit from it, a long waiting list developed, and an obvious way of trying to reduce the waiting lists and help more people without having to train many more therapists, was to have the repetitive aspects of the effective treatment taken over by the computer.

Anita Barraud: So you see it as a way of democratising mental health in a sense?

Isaac Marks: Exactly, mental health care for all -- but for particular problems.

Natasha Mitchell: Isaac Marks. Nick Titov also thinks cognitive behavioural therapies delivered by a computer could make stretched mental health services more accessible to more people. In Australia and New Zealand, for example, some 40% of those experiencing anxiety disorders fail to seek treatment. Nick Titov is speaking to Anita Barraud.

Nick Titov: It's important to bear in mind the CCBT covers a broad range of different techniques: everything from therapist based contact with some supplementation using computers and technology, all the way to stand alone systems without any clinician input.

Anita Barraud: In fact you make a clear distinction between CCBT online by yourself and assisted therapies.

Nick Titov: Yes, I think that's a very important distinction and I think as the literature continues to grow it's quite clear that these systems which include therapist contact certainly result in much better clinical outcomes for our patients. Now that's not to say that there isn't a place for completely computerised CBT systems. For example Moodgym and the like can be very effective for people who are highly motivated and quite determined.

Anita Barraud: And welcome to the first lesson of the social phobia education program. An important part of this program is to read about John.

Nick Titov: We have 100 people who have been enrolled, 35 of whom have completed so far, and the results are certainly very encouraging results, comparable to what we'd expect from face to face treatment.

Anita Barraud: Now John is a shy uni student who's in danger of dropping out but he goes to his psychologist aunt to confront his problem. And so the program effectively goes through John visiting his aunt and dealing with his issues, which possibly would parallel with their own issues.

Nick Titov: Look that's exactly right. What we are using is essentially a storytelling technique to provide education about social phobia, to provide education about treatments and to talk about the treatment process, if you like, the journey that people take when they're engaged in treatment.

Anita Barraud: Poor John, I feel hot and dizzy, I'm finding it hard to breathe he says, I'm so pathetic, I can't even pass someone a pen without getting anxious.

Nick Titov: And those are classic symptoms of social phobia; so the strong physical symptoms of social phobia with the increased respiration, are the increased heart rate, the sweating and so on, the shaking -- as well as all those negative cognitive or thinking type symptoms where people worry and expect the worst in terms of what other people might say or think about them.

But with cognitive behaviour techniques we're encouraging patients to look at themselves and to do a stocktake of the things they do and the things they think which may or may not help their symptoms.

And so they can identify those behaviours or thoughts which are maladaptive and we can show them some techniques for challenging and changing those behaviours and thoughts so they gain more control and mastery over their symptoms.

Transcript continued at All in the Mind.