An interactive self-help program may serve as an artificial counselor to
help astronauts solve psychological and interpersonal problems during
prolonged space flights or extended stays in a space station.
This self-guided, multimedia computer program is intended to treat
depression using an established behavioral-treatment approach known as
problem-solving therapy, which is widely used in psychotherapy in primary care
settings, James Cartreine, Ph.D., the principal investigator on this project,
told Psychiatric News.
The user is guided through the program's series of steps by the prerecorded
voice and image of a psychologist (in this case, Mark Hegel, Ph.D., an
associate professor of psychiatry and community and family medicine at
Dartmouth Medical School).
First, the user is instructed to make a list of concrete, measurable,
objective problems being experienced that exacerbate his or her low mood and
can directly be addressed by new behaviors such as regular exercise or
increased interpersonal interactions. Second, the user is asked to choose one
problem from the list that has a reasonable likelihood of being solved and to
then devise a clear and specific goal that marks the ultimate solution of the
problem. The user is encouraged to brainstorm different ideas to come up with
many possible ways to reach the solution of the problem and, with the help of
the computer, chooses the action that is most likely to solve the problem.
"This is a step-by-step, structured process, which lends itself to a
computerized approach," said Cartreine, a psychologist in the Division
of Clinical Informatics at Boston's Beth Israel Deaconess Medical Center."
The computer program is like an interactive workbook to help the user
solve problems." He noted that the computer program does not solve the
problems for the user, but rather facilitates an individual's own
problem-solving behaviors, thus mimicking the strategy of a live therapist in
National Space Biomedical Research Institute scientists James Cartreine,
Ph.D. (left), and Jay Buckey, M.D., conduct a test run of a self-treatment
program for depression on the Virtual Space Station.
Credit: James Cartreine, Ph.D.
The program uses the validated nine-item depression scale in the Patient
Health Questionnaire, known as the PHQ-9, to assess the severity of the user's
depression symptoms at baseline and track clinical progress over time.
The self-guided treatment program is one module of a suite of programs
known as the Virtual Space Station. It was developed for NASA and funded by
the National Space Biomedical Research Institute, a consortium of
organizations and institutions devoted to researching health risks in
long-duration space flights. Two additional modules for managing interpersonal
conflicts and self-treatment for anxiety and stress are in development.
Astronauts are screened for physical and mental health and are generally
less vulnerable to illnesses than the average person. But long space flights
pose unique challenges to even an otherwise tough person, Jay Buckey, M.D., a
professor of medicine at Dartmouth Medical School and a co-investigator on the
project, told Psychiatric News. He was an astronaut at NASA in the
1990s and flew on a 16-day mission aboard the Columbia space shuttle in
Many astronauts, however, participate in missions that are much longer than
Buckey's. For example, a stint on board an international space station usually
lasts four to six months, which could be psychologically challenging.
"On a long flight, if the mission isn't going well, and the crew is
in conflict, and no one is getting enough sleep, you can imagine that may be a
situation where depression could develop," Buckey said. The isolation
and stress may have a significant impact on astronauts' mental health.
The depression self-treatment program has been tried by several researchers
stationed in Antarctica, where the isolated condition mimics that of long
space flight. A randomized clinical trial of the program, led by Cartreine,
was slated to begin in October at Beth Israel Deaconess and would assess the
program's effectiveness in 100 volunteers with mild to moderate
Both Cartreine and Buckey noted that this self-treatment program may be
useful for not only astronauts but also the general patient population, and
that NASA is interested in spinning off its technology for civilian use.
"It does not replace a psychologist or a psychiatrist," said
Buckey. "But it can guide the user to identify [his or her]
problems" and then provide instructions on how the user can take steps
to solve those problems. "Even people who are not depressed can find it
helpful," he said. Cartreine added that it also can be used in
conjunction with in-person therapies and medications.
"The field of computer-based psychotherapy is still very new,"
Cartreine noted. "Research has shown that people are more willing to
admit embarrassing problems to a computer than to a live
person—[problems] such as suicidal or homicidal ideations, certain
sexual behaviors, and addictions." In other words, he said, a computer
is often perceived in patient interviews as being less judgmental than a live
A description of the Self-Guided Depression Treatment on
Long-Duration Spaceflights is posted at<www.nsbri.org/Research/Projects/viewsummary.epl?pid=155>.▪