Professional Edition

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 clinical practice.

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 following topics:


Note: 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. 


What is 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: 

· Reduce the total time required to treat each patient, thus allowing the therapist to treat more patients. 
· Improve payment for therapy
· Speed the process of therapy 
· Combine with medication and brief therapy in a highly efficient treatment package 
· Provide psychoeducation 
· Prepare patients to start group or family cognitive therapy 
· 
Provide cognitive therapy in settings where there is a shortage of trained therapists 
· 
Monitor progress of therapy 


Program Synopsis

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 Workbook. 

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:
  

Introduction 

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. 




Taking Action

Behavioral interventions 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 this section. 





Changing Schemas 

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.

Several useful 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 lesson.

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. 


Confidentiality 


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. 


Training Applications 

Although the 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.


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