NetNews Usenet Archive 1993 #3/NN_1993_3.iso/spool/sci/med/24441

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Subject: Description of Overcoming Depression 2.0
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By popular request, here is a brief description of
OVERCOMING DEPRESSION 2.0

The New Upgraded 1993 Version
Kenneth Mark Colby, M. D. and Peter MacKenzie Colby
Malibu Artifactual Intelligence Works
25307 Malibu Rd., Malibu, CA 90265  1-800 497-6889, [phone]

OVERCOMING DEPRESSION 2.0

Gain insight into your depression and use Overcoming Depression
2.0 as a new computer-mediated cognitive therapy method to
alleviate it and achieve greater happiness.

Overcoming Depression 2.0 allows you to conduct a therapeutically
meaningful conversation with the program in everyday language.

"I have to admit I was initially skeptical ... But I am pleased
to report that "Overcoming Depression" is an intriguing gem of
a program ... It's divided into lessons ... at the heart of each
lesson is an absolutely amazing dialogue that you have with the
computerized therapist."  Dennis Lynch, Chicago Tribune,
Programs to Improve Your Life.  July 31, 1992.

"This computer program is of potentially limitless value for
people attempting to help themselves overcome depression."
James E. Spar, M. D., Department of Psychiatry, UCLA School
of Medicine.

"Despite my initial skepticism, the program was so helpful
that I now keep printouts of my sessions in a locked file ...
I was impressed by its ability to comment and respond in
natural language ... surprisingly personal and insightful."
Kathleen McAuliffe, SELF magazine, July, 1991.

"Excellent program.  Very helpful."  Lancaster, Ohio.

"I am very enthusiastic about the program."  Oxford, England.

            INTRODUCTION

    You are not alone.  Depression is a very common
affliction, with 25% of the United states population being
depressed at some time in their lives.  In any given month,
5.5% of us are depressed (1).  Over 20 million Americans
are depressed.

    Until quite recently, science had little to offer the
majority of depressed people.  In the past few years, cognitive
therapy has been shown, in several controlled scientific studies,
to be highly effective in alleviating depression. Moreover its
recipients stay free of depression longer than those treated solely
with drugs and there are far fewer relapses (2-7).  In one
controlled study, a cognitive therapy program was as effective as a
human therapist (8).  Computer-assisted therapy has also been very
sucessful in stress-related conditions (9).  The fields of artifical
intelligence and cognitive therapy have now been combined to
produce a unique computer-mediated therapeutic tutorial program
for you - OVERCOMING DEPRESSION 2.0.

    OVERCOMING DEPRESSION 2.0 is the world's first-ever
computer cognitive-therapy tutorial program for understanding and
dealing with depression using a unique dialogue mode that allows
you to express yourself freely in your own words and which responds
in meaningful everyday language characteristic of therapeutic
discourse.  The content of this tutorial program is based on two
fundamental principles of cognitive therapy.

    (1) Depression results from the way you think about yourself.

    (2) The mind is naturally designed to heal itself given
        the right sort of help.  Hence you can change your
        thinking and moods by the application of specific
        cognitive strategies.

To overcome depression, you need to learn a new way to think about
yourself.  You can help your mind to help itself.  You will learn
here how to give up a way of thinking and replace it with a way
that is more right for you to achieve greater happiness.

    OVERCOMING DEPRESSION 2.0 is not intended to represent a
computer simulation or imitation of a human therapist.  It introduces
a new entity into the world, a unique therapeutic method in its own
right with its own style, assets and limitations.  This cognitive -
therapeutic program has two modes of operation, a text mode and a
dialogue mode.

    The text mode is educational and instructional in nature.
The dialogue mode represents a unique type of conversational
participant designed to conduct therapeutically relevant
conversations by interpreting and responding appropriately to
everyday natural language input in its own intriguing way. In
addition to discussing your depressed condition, the dialogue
mode is capable of conversing about close interpersonal relations
such as those with your wife, your husband, your girlfriend, or
your boyfriend.  It can even discuss your thoughts and feelings
about the program itself when you address the program as "you".

    The program's dialogue mode has limitations in that it
does not possess the full sophisticated linguistic capacities of
an educated adult human.  Its purposes are to encourage free
expression, to help the user put his thoughts and feelings into
words, to allow the assertion of one's individuality, to be
supportive, to arouse emotion, to excite interest, to call attention
to aspects of your situation you may not have considered, and to
promote cognitive action. It is intended to function as a catalyst
and complement to the educational text which provides the bulk of
the information for therapeutic learning.  It has a recognition
vocabulary of 60,000+ words and phrases and a response output of
20,000+ expressions.

             ABOUT THE AUTHORS

    OVERCOMING DEPRESSION 2.0 was created by Kenneth Mark Colby,
M.D. with the programming assistance of his son Peter M. Colby, and
noted social scientist Julian L. Simon, Ph.D., Professor at the
University of Maryland, who contributed to the theoretical and
observational basis for the program's approach to depression.
Dr. Colby is Professor of Psychiatry and Biobehavioral Sciences,
Emeritus, at the University of California School of Medicine at
Los Angeles.  He is a graduate of Yale University and its School
of Medicine.  He practiced psychiatry and psychotherapy for over
20 years, writing a classic text on psychotherapy entitled A PRIMER
FOR PSYCHOTHERAPISTS. He also contributed the section on
PSYCHOTHERAPY OF MENTAL DISORDERS to the INTERNATIONAL ENCYCLOPEDIA
OF THE SOCIAL SCIENCES.  Dr. Colby was Professor of Computer Science
specializing in artifical intelligence at Stanford University
before moving to UCLA where he also held a joint appointment as
Professor of Computer Science.  He is the author and coauthor of
10 books and over 100 articles in the fields of psychiatry,
psychology, psychotherapy, and artificial intelligence.

    Peter M. Colby was lead programmer at Interactive
Health Systems, Santa Monica, California, from 1985 to 1989,
where he implemented several new programming languages for creating
therapeutic learning programs that have proved to be successful in
helping thousands of people.  He now runs his own computer consulting
company, Malibu Coast Computers. He is also coauthor of articles
on computer-assisted psychotherapy.


          HOW TO LEARN FROM THE PROGRAM

    This computer-mediated cognitive-therapeutic program first
teaches you in a systematic way about the factors involved in
depressive conditions. There is no single kind of depression.
Instead there are many types of depression and several strategies
for dealing with each of them.  The program shows you in a step-by-
step manner how you can understand the factors in your own
depression and overcome them so you can live with less pain
and greater happiness.

    How does a computer program help you overcome depression?
First, by presenting facts and explanatory concepts about depression,
a program can help in the same way self-care books inform you about
bad-back problems or controlling cholesterol levels.  Having acquired
the appropriate information about depression, as your own
therapeutic-change agent you can learn to carry out the cognitive
strategies necessary for overcoming your particular depression.

    Second, in contrast to a book, OVERCOMING DEPRESSION 2.0
has the ability to participate in the give-and-take of real-life
conversations.  Conversations with the author of a book can only
be imaginary.  Interactive conversations with OVERCOMING DEPRESSION
2.0 allow you to express yourself freely in everyday natural
language and receive conversational responses relevant to the
therapeutic context.

    OVERCOMING DEPRESSION 2.0 is organized in a progressive series
of seven tutorial lessons as follows:

Lesson #1 - NEGATIVE SELF-COMPARISONS
    How the central process of negative self-comparisons leads
    to depressive states of sadness and low self-esteem, often
    accompanied by a sense of hopelessness-helplessness.

Lesson #2 - MOOD RATIOS AND VALUE DIMENSIONS
    The concept of a mood ratio is introduced in which an
    out-of-balance mood ratio results from comparing your
    PERCEIVED-ACTUAL SITUATION and an IMAGINED IDEAL SITUATION.
    The VALUE DIMENSIONS along which you make the comparisons
    are those of importance in your self-image.

Lesson #3 - IDEAL STANDARDS
    The IMAGINED IDEAL SITUATION of your mood ratio serves
    as a benchmark standard acquired from others in growing up.
    Such IDEALS may now be unrealistic or unsuitable for you
    as an adult.  To combat depression, you must reprogram
    yourself to free yourself from these self-defeating IDEALS.

Lesson #4 - REPROGRAMMING YOURSELF
    How you can reprogram yourself by rejecting negative
    self-comparisons and by constructing new dimensions for
    your mood ratio.

Lesson #5 - OBSTACLES TO OVERCOMING DEPRESSION
    Physical and environmental factors can serve to hinder
    overcoming depression.  Also taken up are the paradoxes
    of excuses and self-pity.

Lesson #6 - CHANGING VALUES
    In this lesson you learn a systematic procedure for
    discovering, weighting, and re-ordering values in the
    set of values important to you.  Revising your goal-values
    has a powerful effect in alleviating depression and
    achieving happiness because they involve the deepest
    aspects of your self-image.

Lesson #7 - SUICIDE AND ANTIDEPRESSANT MEDICATION
    These topics are optionally discussed.  Because of
    narrowed thinking, the depressed person considering
    suicides fails to see significant alternative options.
    A test is offered which assesses whether or not you
    are a candidate for antidepressant medication.  The commonly
    used drugs and their side effects are taken up in detail.

    At various places in each lesson, the program enters
its unique dialogue mode.  In this mode, you may type in whatever
you want to say using your own words.  The program is capable of
correcting thousands of input spelling errors.  The program's
responses are designed both to facilitate free expression on the
part of the user and to call attention to aspects of the user's
situation he may not have considered.  At times, the dialogue
mode may make mistakes in interpretation due to the current
primitive state of the art of computer understanding of
conversational language.  With a spirit of tolerance, these
grammatical glitches can be easily overlooked by the charitable user.

    Here is an example of the dialogue mode in Lesson #1:

PROGRAM -    We were talking about your depressed feeling.
        What else can you tell me about them?
USER -        I have been down in the dumps now for
        six months.

PROGRAM -    It must be a burden to feel so depressed.
USER -        It is.  I feel like I'm drowning in a swamp.

PROGRAM -    What in particular depresses you?
USER -         Mornings.  I can't get out of bed in the
        morning.

PROGRAM -    It must be hard to get up when you have
        nothing to look forward to.
USER -         Right.  I hate the idea of going to work.

PROGRAM -     What in particular don't you like about your
        work?
USER -         My wife says I have a dead-end job and I agree.

PROGRAM -     What makes you feel you can't do anything about
        your situation?
USER -         I feel helpless to change anything.

PROGRAM -    Some of your sense of helplessness comes from
        a mistaken belief that there is nothing you can
        do on your own to improve your condition.

    After each session you can print out a permanent
record of your lesson, including the dialogues.  You may even
want to go back over a previous lesson.  Carry out the recommended
homework exercises because they are an essential part of therapeutic
learning.  Each lesson is packed with explanatory information
and useful cognitive strategies for relieving depression.  Save
your print-outs and you will have an entire reference work
on the subject of your depression.

    A single pass through the lessons is not sufficient to
produce lasting benefit.  To thoroughly absorb and solidify
therapeutic learning, run the program many times, repeating
and rehearsing thse lessons that apply particularly to your
own condition.

    OVERCOMING DEPRESSION 2.0 comes in two versions,
a Personal Version and a Professional Version.  The Personal
Version is designed for use by one person by himself.  The
Professional Version can handle multiple users and can serve
as a therapeutic adjunct for the mental health professional.
The manual for the Professional Version discusses various
ways in which the program can share the professional's
workload and reduce the cost of therapy for the individual user.

    The Professional Version of OVERCOMING DEPRESSION 2.0 is
currently being used by university hospitals and clinics, by HMOs,
by the Veterans Administration, by the U.S.Navy, as well as by many
therapists in private practice in the U.S. and internationally.
It is also being systematically evaluated in controlled clinical
trials in both university and VA settings.

    The 1993 program OVERCOMING DEPRESSION 2.0 represents an
upgrading of the previous edition OVERCOMING DEPRESSION 1.0 by
the addition of instructional text and by more than doubling
the dialogue capacities for therapeutic discourse.  The program
is written in the language C and runs on any IBM compatible PC
with 640K RAM and a hard disk.  It consists of a 1.3 megabyte
data-base and a 100K interpreter.  It also can be run on an
Apple MAC using the program Soft PC.

    OVERCOMING DEPRESSION 2.0 is available on 5.25" and
    3.5" diskettes.

            REFERENCES

(1)  Regier, D. A., Boyd, J. H., Burke, J. D., et al. (1989)
    One-month prevalence of mental disorders in the United
    States.  Archives of General Psychiatry, 45:977-986.

(2)  Beck, A. T., Shaw, A. J., Rush, B. V., and Emery, G. (1979)
    Cognitive Therapy of Depression, New York:  John Wiley.

(3)  Rush, A. J., Beck, A. T., Kovacs, M., and Hollon, S. (1977)
    Comparative efficacy of cognitive therapy and pharma-
    cotherapy in the treatment of depressed outpatients.
    Cognitive Therapy and Research, 1:17-37.

(4)  McLelan, P. D. and Hakstian, A. R. (1979) Clinical depression:
    comparative efficacy of outpatient treatments.  Journal
    of Consulting and Clinical Psychology, 47:818-836.

(5)  Blackburn, I. M., Bishop, S. B., Glen, A. E. et al. (1981) The
    efficacy of cognitive therapy in depression:  a treatment
    trial using cognitive therapy and pharmacotherapy, each
    alone and in combination.  British Journal of Psychiatry,
    139: 181-189.

(6)  Kovacs, M., Rush, A. J., Beck, A. T., et al. (1981)  Depressed
    outpatients treated with cognitive therapy or pharma-
    cotherapy:  a one year follow-up.  Archives of General
    Psychiatry, 38: 33-39.

(7)  Hollon, S.  D., DeRubeis, R. J., and Evans, M. D. (1990)
    Combined cognitive therapy and pharmaco-therapy in the
    treatment of depression.  In D. Manning and A. Frances,
    eds.  Combination Drug and Psychotherapy in Depression.
    Washington, D. C.:  American Psychiatric Press.

(8)  Selmi, P. M., Klein, M. H., Greist, J. H., Sorrell, S. P
    and Erdman, H. P. (1990)  Computer-administered cognitive-
    behavioral therapy for depression.  American Journal of
    Psychiatry, 147: 51-56.

(9)  Colby, K. M., Gould, R. L., and Aronson, G. (1989)  Some
    pros and cons of computer-assisted psychotherapy.
    Journal of Nervous and Mental Disease, 177: 105-108.