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Vital Signs

Feeling low? Help may soon arrive from on high

By Boer Deng

Psychiatrists' couches could begin gathering a layer of dust if a new depression self-treatment program catches on. It was developed, with support from the National Space Biomedical Research Institute, by a team that includes Dr. Jay Buckey, a DMS faculty member and former astronaut.

Module: The program allows users to seek help confidentially, using a computer-based therapy module that is part of a multimedia initiative called the Virtual Space Station. Although developed for use by astronauts on long-duration space flights, the module may eventually become a tool to address mild to moderate depression in patients on terra firma.

"Depression is a problem with mood regulation," Buckey explains. Though periods of high or low mood are normal, depression is considered to have set in when an individual loses the ability to emerge from very low periods. This begins to affect the individual's motivation to perform and complete everyday tasks. In the context of a space mission, a depressive disorder could seriously affect the individual's performance and even threaten the mission. "Though it's not common" in astronauts, says Buckey, "the impact of depression can be severe."

Despite the potential seriousness of the consequences, mood regulation problems often remain unrecognized and unaddressed. Within the space program, the physical and intellectual rigor required of astronauts means that emotional issues are sometimes overlooked.

Even if an individual does feel symptoms of depression, within that setting there can be a great unwillingness to come forth with this information. "You're dealing with a population that isn't going to want to talk about psychological problems," Buckey explains. "In some environments," he rues, "discussing psychological problems is sometimes viewed as a sign of weakness."

The result is that astronauts may not deal with these important issues "unless they absolutely have to," says Buckey. But, he adds, "if you waited for a problem to get so severe it needs urgent action, you've probably waited too long."

Buckey hopes the confidential nature of the self-treatment module will help overcome the stigma that causes psychological issues to go unaddressed. The program begins with a questionnaire to help users understand the symptoms of depression, followed by suggestions based on their responses.

Steps: If users are suffering from mild or moderate depression, they're guided through a problem-solving therapy program. This consists of a series of video sessions conducted by Dr. Mark Hegel, a psychologist at DMS. Hegel offers coping suggestions by breaking the problem into small steps. Buckey says when individuals are given discrete, tangible goals, they often "will start to feel better, . . . gain control over their lives, and improve their mood." Users can also keep a confidential log of their experiences as part of the treatment module.

Earth: Since depression carries a stigma even on Earth, the team hopes the module can one day be used outside the space program. They have just finished developing a version aimed at a general, technologically literate audience that is now ready to be tested in a clinical trial.

The trial will compare the effectiveness of the self-treatment module against standard therapy methods. Buckey hopes that this new, confidential, interactive approach may change the structure of depression care, not only in space, but on the ground as well.

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