Treating depression with Virtual Space Station


An Interview with:
James A. Cartreine, Ph.D.
Brigham and Women’s Hospital
NSBRI Neurobehavioral and Psychosocial Factors Team

Courtesy of EarthSky Communications

James Cartreine: One of the problems that can come up on long space missions are psychological problems and social problems. They can really be show-stoppers.

James Cartreine is a clinical psychologist at the Harvard Medical School. He told EarthSky that astronauts on space missions must cope with long periods of isolation and close working conditions with others. That puts them at risk of depression and conflict with their crewmates. Dr. Cartreine is working with the National Space Biomedical Research Institute to develop self-help software for mental health called the Virtual Space Station.

James Cartreine: The Virtual Space Station has an interface that allows the astronaut to go into different kinds of resources. There are pre-mission training resources to prevent and manage problems like depression, stress, anxiety, interpersonal conflict. And then there's onboard self-assessment to find out if you have problems currently with depression, or with stress or interpersonal conflict, that kind of thing.

Going to a computer for help with difficult personal problems might seem odd at first. But Cartreine said it can work.

James Cartreine: The research has shown, very consistently, that people are more willing to open up to computers than to therapists, even the most non-judgmental therapists, especially about embarrassing things.

A limited trial of the Virtual Space Station has shown good results in treating depression, said Cartreine. Future tests with firefighters and EMTs could help launch widespread use of the self-help software. Dr. Cartreine gave more detail about how the Virtual Space Station is actually used.

James Cartreine: There are a variety of resources. There are interviews with former astronauts, and other people who work similar operational environments, such as military, firefighters who have had similar experiences that are relevant that they can share. There are full-length books that they can read. But the real core of the Virtual Space Station at this point is the training and the self-guided treatments.

The self-guided treatment involves special problem-solving techniques, says Cartreine.

James Cartreine: In the self-guided treatment, you're basically walked through a full set of therapy sessions by an expert psychologist. In this case, it's Dr. Mark Hegel, who is a psychologist at Dartmouth Medical School. Mark is an expert in a treatment called problem-solving treatment for depression. And problem-solving treatment is shown to be effective in one-on-one settings. In problem-solving treatment, we basically guide people through the process of identifying the problems they're currently facing, choosing a problem to work on that they have some control over, setting goals, brainstorming ways to reach those goals, making an action plan to implement, in the near term, and then also scheduling some pleasant activities, because enjoyable activities are important, especially for people who are managing depression.

Dr. Cartreine spoke more about the differences between going to a computer versus a live person for counseling with difficult personal problems.

James Cartreine: One-on-one psychotherapy is difficult to present through computer means. The computer doesn't know English. It's not going to have a literal conversation with you. It's not going to talk back to you about what you just said. What it can do is store things that you put in, and then feed them back to you. We have to find a way to present the therapy recognizing the limits of what a computer can do. In problem-solving treatment for depression, one of the things is stating your goal. You goal is, "What would you like to have different with this particular problem in your life?" Well, the user types in their goal, "My goal is to be able to pay my bills every month." That's a good goal. The computer can then feed it back to you and say, "Here's the goal that you stated. Now let's come up with some ways to reach that goal." The computer doesn't read what you just typed and discuss it intelligently. It can't do that. But at the same time, the computer can help you to go through the process of what you would do in a therapy session.

Dr. Cartreine hopes that the Virtual Space Station will eventually be tailored for widespread public use, available to anyone with a computer.

James Cartreine: My background is as a clinical psychologist, but I started out as a video producer, an interactive media producer. I've always been interested in how to combine these fields. Now, there's no shortage of depression in the world. There's no shortage of interpersonal conflict, of stress, of anxiety. Everything we're building for the astronauts has the potential to benefit the general public. We're really building that with the general public in mind. At my professional core, I'm very interested in public mental health.