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The very idea of psychotherapy seems to defy the instant-access, video screen chatter of popular digital culture.

Not for long, if some scientists have their way. In the past few years researchers have been testing simple, video-game-like programs aimed at relieving common problems like anxiety and depression. These recent results have been encouraging enough that investigators are now delivering the programs on smartphones — therapy apps, in effect, that may soon make psychological help accessible anytime, anywhere, whether in the grocery store line, on the bus or just before a work presentation.

The prospect of a therapy icon next to “Angry Birds” and “Fruit Ninja” is stirring as much dread as hope in some quarters.

“We are built as human beings to figure out our place in the world, to construct a narrative in the context of a relationship that gives meaning to our lives,” said Andrew Gerber, a psychiatrist at Columbia University. “I would be wary of treatments that don’t allow for that.”

The upside is that well-designed apps could reach millions of people who lack the means or interest to engage in traditional therapy and need more than the pop mysticism, soothing thoughts or confidence-boosters now in use.

‘’That is what makes the idea so promising,” said Richard McNally, a psychologist at Harvard whose lab recently completed a study of 338 people using a simple program accessible on their smartphones. “But there are big questions about how it could work, and how robust the effect really is.”

In lab experiments, some researchers have seen very strong results, “with effect sizes like you’d see in regular therapy,” said Nader Amir, a psychologist at San Diego State University. In a series of experiments, Amir found that about half of people with an anxiety disorder who completed a full course — practicing on a computer for about 30 minutes twice a week, for four to six weeks, in a lab setting — improve enough that the diagnosis no longer applies. He has tested programs that target social anxiety and generalized anxiety disorder and is part-owner of a company that is marketing the technology.

A study among 40 children with chronic anxiety, published in December, found that a similar attention-bias program produced “significant reductions in the number of anxiety symptoms and symptom severity,” according to the authors, who included Daniel Pine of the National Institute of Mental Health and Yair Bar-Haim of Tel Aviv University.

Psychologists in Europe have even tried a bias modification program aimed at heavy drinking — a computer task in which people push away images of alcoholic drinks, using a joystick, and zoom in on nonalcoholic ones — and found that it improved the effectiveness of talk therapy aimed at reducing the habit.

Other researchers have not had quite the same success. “I am far from convinced that this is for real,” said Willem Van der Does, a psychologist at Leiden University in the Netherlands, who has several papers under review testing bias modification.

“I did not notice any positive effect,” one woman with social anxiety who participated in the Harvard study said in an e-mail. “It seemed similar to when I played ‘Scramble’ or other games on my phone.”

In a review of studies of bias modification, researchers at the University of Pennsylvania concluded last summer that the technique had a small effect that “significantly modified anxiety but not depression.” The authors also noted that there was evidence of what scientists call a “file drawer” problem — in which studies finding no effect are filed away or ignored, while encouraging ones are published. “I think in this field the standards for publishing positive studies are lower than for negative ones,” Van der Does said.

It is perhaps fitting that the largest study to date — by Phil Enock, a graduate student at Harvard; Stefan Hofmann, of Boston University; and McNally — produced results that were both encouraging and confusing. The team began recruiting participants in summer 2010, using Craigslist and online bulletin boards for social anxiety.

In March 2011, they were flooded, after an article in the Economist magazine about cognitive bias modification mentioned the project. Months later, after 338 participants with anxiety symptoms completed a total of more than 4,000 sessions of the two-face therapy application, the researchers had some results.

Participants who got the treatment improved their scores on a questionnaire measuring anxiety, dropping by an average of 22 points, compared with an eight-point drop among people in a “waiting list” group, who got no computer games to play. However, a placebo group in the study practiced with a two-face video program not intended to shift the eyes from one face or the other, and their anxiety levels as measured on questionnaires also fell by about 22 points.

Karin Langer, 34, an architectural historian in Chicago who scored high on some measures of social anxiety, was among those who benefited from the treatment. Langer works at home, interacts almost entirely by e-mail and found herself increasingly anxious about phone conversations with colleagues. “I did notice a difference after using the therapy,” she said. “But it may have been a placebo. I felt good about myself, that I was doing something for my issues, but a lot happened in those two months outside the study that could have helped.”

Stranger still, the people who reported that they had learned about the study from the Economist article responded very well to the program — whether getting the treatment app or the placebo one — as if the article itself had some power of suggestion.

“We’re not exactly excited about that finding; we have no idea what it means,” said Enock, adding that there was still much work to do to determine who best responds to specific types of bias modification and how strong the effect is.

But, he said, “We certainly have shown that you can deliver treatments on smartphones, you can put attention and bias modification tools literally in people’s hands, and there’s no reason to hold back” from testing them.

The New York Times