The material contained
in this portion of the website is intended for doctors and therapists who are
interested in using Good Days Ahead as a tool in
The Professional Edition contains multi-user capacities, and other special
features that provide a full system for computer-assisted cognitive
therapy. Research on the Good Days Ahead program
has demonstrated excellent acceptance by users and improved efficiency of
cognitive therapy for depression.
The program can be used in the clinician's office or the patient's home computer.
The Professional Edition is designed to: (1) help
clinicians help their patients, (2) augment
cognitive therapy or other traditional therapies, (3) provide exposure to cognitive therapy methods if this treatment is
not available, and (4) enhance practice revenues.
To learn more about using the Professional Edition click on the
The material contained in this portion of the website is intended for doctors and
therapists who are interested in learning more about using Good Days
Ahead as a tool in clinical practice.
Computer-Assisted Cognitive Therapy?
The Professional Edition of Good
Days Ahead has been specifically designed for use in
computer-assisted cognitive therapy. In this form of treatment, the computer
program is used as an adjunct to the work of the clinician. It is not intended
to replace any of the essential human elements of the therapy process. But, it
provides a rapid method of educating patients in the basics of the cognitive
therapy approach, promotes use of cognitive therapy self-help, monitors
progress, and gives the therapist feedback on the patient’s experiences in
using the program.
In a randomized, controlled research study, it was found that computer-assisted
cognitive therapy and standard cognitive therapy were equally effective in the
treatment of major depression, even though time with the therapist was reduced
by about one half in computer-assisted therapy. No medications were utilized in
this study. The results of this trial were presented at the 2000 Annual Meeting
of the American Psychiatric Association. Other research has shown very high
satisfaction ratings from people who use the software.
Good Days Ahead has been used
successfully in North America and Europe since 1995 in a wide variety of
clinical and research settings.
The Good Days Ahead program can be used in many ways to
augment the treatment of depression and anxiety. Although the program content
is directed primarily at depression, it also teaches methods such as modifying
automatic thoughts and using graded task assignments that can be helpful for
patients with anxiety disorders.
In clinical practice, most clinicians use the program to increase the
efficiency of treatment or to speed the patient’s acquisition of knowledge and
skills in using the methods of cognitive therapy. Many of the “routine”
procedures of cognitive therapy such as explaining the basic principles of the
treatment model, identifying automatic thoughts or other maladaptive
cognitions, teaching patients how to do thought recording, or implementing
standard behavioral techniques for depression can be done with the computer
program. This frees the clinician for spending more time on the creative or
customized elements of therapy.
How the Program Can Help Clinicians
Here is a short list of some of the
ways in which Good Days Ahead has been used to assist
clinicians in practice:
the total time required to treat each patient, thus allowing the therapist to
treat more patients.
payment for therapy
the process of therapy
with medication and brief therapy in a highly efficient treatment package
patients to start group or family cognitive therapy
cognitive therapy in settings where there is a shortage of trained
progress of therapy
The learning environment includes a
series of engaging videos that show a person using cognitive therapy methods to
fight depression. Users perform a number of interactive exercises, based on the
videos, that teach them cognitive therapy skills. Then they can use these self-help
exercises to work on making changes in their own lives. Feedback is given
throughout to enhance learning and encourage users to put cognitive therapy
methods into action.
A “Workbook” is included with the program that stores all of the self-help
exercises in which users enter information from their own lives. Users can go
back to the Workbook at any time to review their earlier work or to get
additional practice in using the self-help exercises. Every time a patient uses
the program, suggestions are made for “homework” to be done in the
If users do not want to type in any of their own information, or have no skills
in using a keyboard, they can still benefit from using the program. All of the
video based exercises can be done by making selections with a mouse. Research
with this program has shown that it requires reading skills at the ninth grade
level, but no previous computer experience is required. The entire Workbook can
be printed out so that users who prefer writing out their self-help exercises
by hand can do so.
The total amount of time required to go through all
the lessons in Good Days Ahead program usually ranges
from five to eight hours. It is usually recommended that users spend
about 30-60 minutes during each session on the computer.
The software can be used in the clinician’s office or by using the Self-Help
Edition in the home setting.
Here is a brief description of the content of each module of the program:
In this brief initial
section, users: (1) become familiar with the learning
environment; and (2) answer questions that provide baseline
sociodemographic and clinical data. By the end of the Introduction, patients
should be able to operate the learning system on their own.
Changing Automatic Thoughts
The main objective of
this segment is to help patients learn about the interplay between
dysfunctional thoughts, emotions, and behavior. The main character, Joan, is
seen in her kitchen visiting with her best friend, Karen. It's immediately
apparent that Joan is depressed and that she's having negatively distorted
thoughts. Initially, Joan's negative thinking leads to a maladaptive response
to her friend's offer of help. But, the scene is played out to a much more
satisfying conclusion after Joan is able to change her thinking style.
The Basic Principles section is relatively short and requires only modest
effort from the majority of patients. However, the message of the lesson is a
powerful one, and an understanding of this material provides an essential
platform for successful completion of the remainder of the program. This early
segment relies very heavily on video to capture attention and to stimulate full
engagement in the learning process.
Users learn about automatic thoughts and start to generate their own “Personal
List of Automatic Thoughts.” They also do self-help exercises such as a Two
Column Thought Record. They are introduced to “homework assignments” and the
Workbook section of the program. Each time they use the program, suggestions
are made for helpful homework exercises that can be done in the Workbook.
Two vignettes from
Joan's life are used to teach patients how to identify and modify automatic
thoughts. In the first scene, Joan is struggling with a series of dysfunctional
automatic thoughts about her work situation. The second video clip shows Joan
at home in the middle of an argument with her husband, Gary.
These vignettes are more emotionally charged than the video material seen
earlier in the program, and thus are more likely to activate the patient's own
cognitions and affect.
During this segment of the program, patients gain experience in using cognitive
therapy techniques such as thought monitoring, identifying cognitive errors,
"examining the evidence," and generating alternative thoughts. The
centerpiece of the lesson is a series of exercises that help patients to
complete thought records (Thought Change Records). After completing this
section of the program, users are encouraged to do homework assignments that will
give them further practice in modifying their own automatic thoughts.
This lesson is more complex and time consuming than earlier segments of the
program. Most patients spend about one to two hours working on the Changing
Automatic Thoughts segment, in addition to time they may spend on homework
assignments in the Workbook. It may be useful to repeat portions of the lesson
until patients become proficient at modifying automatic thoughts.
are emphasized in this portion of the learning program. Again, video
illustrations are used to demonstrate core principles and to give patients
opportunities to see the effects of employing cognitive therapy techniques. In
the first scene, Joan uses an Activity Schedule to reverse a pattern of
decreased interest and helplessness. Then she is shown with her husband in her
home office as she begins to tackle an "overwhelming" task using the
"step-by-step approach." The second video helps patients practice using
a standard behavioral procedure - the graded task assignment.
This portion of the learning program is not as emotionally charged as other
segments, but most patients are able to identify with the common behavioral
dilemmas that Joan must face (for example: decreased interest in activities,
inertia, and procrastination). It usually takes an hour or more to complete
Because schemas are
thought to be the underlying templates (attitudes, rules, or assumptions) that
drive more superficial cognitions, they may not be readily apparent to the
patient. Thus, considerable effort may be required in cognitive therapy to
uncover these structures. In this segment of the program, patients are taught
several ways of identifying schemas including: (1) examining patterns of automatic
thoughts; (2) reviewing past experiences; (3) reading about the experiences of others; and (4) using a schema check list.
procedures for changing schemas (examining the evidence, listing advantages and
disadvantages, and generating alternatives) are covered in this
section. Most users require one hour or more to complete all of this
Changing Schemas is
somewhat more demanding than earlier segments because users are asked to
recognize underlying dysfunctional attitudes and to practice methods of
reversing these firmly held cognitions. The learning program strongly advises
patients to work on schemas in ongoing psychotherapy. Although the computer
program may help patients become more aware of the effect of schemas,
fundamental change may require sustained therapeutic efforts.
The Good Days Ahead software
is designed to provide confidentiality for users. Each person chooses their own
private password to use the system. Mindstreet does not collect, store, or analyze any personal data
entered in the Good Days Ahead program.
Professional Edition of Good Days Ahead is
designed primarily for use in clinical practice, it also can be utilized to train
students and health care professionals in cognitive therapy. The program covers
the basic features of cognitive therapy, and offers a "hands on"
experience in using common treatment procedures. Trainees in medicine,
psychiatry, psychology, nursing, and social work can rapidly acquire a working
knowledge of cognitive therapy by using the computer program.