Eighty-four chronic phobic patients were randomly assigned to self-exposure in vivo instructed by either a psychiatrist, a computer or a book; mean therapy time per patient was respectively 3.1, 3.2 and 0 hours. Seventy-one patients completed treatment. All three groups improved substantially and similarly to 6 months follow-up, with no significant difference between them; self-exposure treatment was effective even without therapist contact. Among the three groups, initial expectation of help and positive attitude to the psychiatrist were equally high and related to subsequent rating of help received. All three groups rated the psychiatrist as more tolerant, reliable, and understanding than the computer or book, but these attitudes did not relate to outcome, were initially similar among all three groups, and changed minimally at 6 months follow-up.

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SynopsisA program on an inexpensive microcomputer was designed to elicit personal histories from patients in a general psychiatric ward. Their answers were compared with the information recorded by the responsible psychiatric team. Where answers disagreed with the clinicians' records, the patient was interviewed to investigate the discrepancy. In the computer-elicited case-histories 90% of items were correct; a further 3% of items were considered correct by the patient. Most patients' computer histories revealed several items unknown to the clinicians and of importance in the management of the patient. Most patients (88%) found that the computer interrogation was as easy as a clinical interview. Computer assessment is proposed as a useful technique for the routine assessment of patients to augment the clinician's findings and to allow him to concentrate on the most relevant areas.

Twenty phobic outpatients were treated by 9 weekly "interviews" at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75-80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-up in both groups.

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