At 249 million miles away, astronauts living on Mars may face loneliness, depression and other forms of mental illness. To help those in remote areas, like outer space, find relief from depression, Geisel School of Medicine professors Mark Hegel and Jay Buckey and Harvard Medical School psychiatry instructor JamesCartreinedeveloped a computer-based therapy program called electronic problem-solving treatment, or ePST.
The program was designed for a hypothetical NASA mission to Mars, during which astronauts in need of psychological help would be handicapped by the five to 20 minute time delay on communication between Earth and Mars. Astronauts on long-duration missions with a limited group of people and minimal opportunity to interact with others outside the group are at high risk for stress, personal conflict and depression.
Hull co-authored a paper with Hegel in 2008 about how non-electronic problem-solving therapy helps depression and benefits people who generally avoid their problems. This finding applies to astronauts, who desire to be autonomous and self-directed.
Hegel and Buckey said the research led them to decide that computer-based programs would be a good approach to helping astronauts, as they allow users to complete the regimens on their own and from a distance.
The program is driven by the concepts of cognitive-behavioral therapy, which challenges people to reflect on and change their negative thoughts, resulting in increased positivity, Buckey said. It does not rely on dispensing medication, he added.
The program faces a significant challenge with user engagement, since in order for it to be successful, astronauts using it must find computers a credible form of treatment and build trust with their therapist.
In ePST, astronauts seeking treatment first complete a test to diagnose their level of depression. Based on these results, users will then interact with pre-recorded videos of Hegel answering questions and providing a treatment schedule, Hull said.
After the user completes the treatment schedule, the program will prompt the user to reflect on his or her experience.
Hegel and Buckey, with assistance from Hull, conducted a trial to evaluate the program’s feasibility, credibility and therapeutic alliance in treating depression.
Buckey presented the results of the trial at Dartmouth-Hitchcock Medical Center last Friday in a lecture called “Even Astronauts Get the Blues.”
Twenty-seven people participated in the original trial, 23 of whom completed at least four of six ePST sessions over nine weeks. Most participants completed all six, Buckey said.
Once the trial concluded, participants were asked to evaluate the program. It scored 5.27 out of seven for acceptability of self-guided treatment, 72 percent on treatment credibility and 79 percent on system usability.
The trial results, compared with Hull and Hegel’s 2008 paper, showed that ePST patients improved more rapidly than those who received traditional therapy.
The model was influenced by Dartmouth’s Interactive Media Lab, directed by Geisel professor emeritus Joe Henderson, Buckey said. Henderson believed experiential learning must be provided whenever possible, and that psychological interventions should be grounded in cognitive-behavioral therapy.
Max Fagin Th ’11, a finalist in the application process for a MarsOne program that plans to establish a human colony on Mars by 2025, said he thinks the psychological problems of space travel are exaggerated.
Boredom and lethargy represent a significant portion of astronauts’ psychological issues due to months of isolation and regimented schedules, Fagin said.
The program would be most effective during the nine-month voyage, Fagin said. Once on Mars, new discoveries and challenges will make everyday life interesting, and a lack of constant supervision due to the time delay will reduce stress.
The program will be a valuable resource in assisting astronauts with unforeseen mental issues, Fagin said.
Elaine Brown, who researches post-traumatic stress disorders, said she believes that ePST is helpful in providing astronauts with the option of therapy. Whether or not the program is effective, the mere presence of a therapeutic option can provide relief.
Brown said she does not believe that ePST will completely replace therapists because it lacks the dynamic interaction and personalized treatments that physicians can offer.
“Flexibility is important, as therapy is extremely interactive, and is tailored to the needs or pacing for each client,” Brown said.
Seeking help that is insufficient can increase stress and, in isolation, astronauts will not have access to social interaction and recreational activities available on Earth, she said.
Yet it is extremely difficult to predict all possible complications and how each may affect the mission’s members, Brown said.
“Most applicants for any mission to space are going to be demonstrably resistant or resilient to psychological impairments, including depression,” Brown said.Brown added, however, that astronauts must have resources for their physical well-being and psychological health, Brown said.
Hegel said he believes the program can also help alleviate similar problems for people living in isolated areas on Earth, like northern New Hampshire. The program was inspired by Hegel’s desire to provide mental health services to those who lack insurance, suitable finances or mental health professionals, he said.
“It’s a lot easier to put a laptop in a primary care clinic,” Hegel explained, “than a professional in a remote area.”
The article has been revised to reflect the following correction:
Correction appended: May 20, 2014
Harvard Medical School psychiatry instructor JamesCartreine, notpsychology professor Jay Hull, developed ePST.
