Use of technology in treatment of mental disorders

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The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as telemedicine [1] or eHealth. [2] [3] [4] The use of such technologies as a supplement to mainstream therapies for mental disorders is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care. [5] [6] Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts. [7] [ page needed ]

Contents

Specific technologies

Traditional methods of helping people with a mental health problem have been to use approaches such as medication, counselling, cognitive behavioral therapy (CBT), exercise and a healthy diet. New technology can also be used in conjunction with traditional methods.

PC devices

TED speaker Jane McGonigal's website Games For Change includes a health category, which presents many mental health improving and education games. Additionally, her own game, Super Better for PC, [8] IOS [9] and Android [10] is also meant for mental health improvement.

Virtual reality

Rizzo et al. [11] have used virtual reality (VR) (simulated real environments through digital media) to successfully treat post-traumatic stress disorder (PTSD). The VR system offers a sense of realism in a safe environment. By gradually exposing the person to their fear with a Virtual Environment the patient becomes accustomed to the trigger of their problem to an extent that it no longer becomes an issue. This form of treatment has also been applied to other mental health problems such as phobias (where anxiety is triggered by a certain situation). For example, fear of flying or arachnophobia (fear of spiders). Computer games have also been used to provide therapy for adolescents. [12] Many adolescents are reluctant to have therapy and a computer game is a fun, anonymous and accessible way to receive therapeutic advice. An example of a computer game that provides such therapy is SPARX, which has notably been shown to be about as effective as face-to-face therapy in a clinical trial. [13]

Mobile devices

Relatively new technology such as mobile phones have also been used to help people with mental health problems by providing timely information. [5] [14]

As technology improves, it may soon be possible for mobile phones or other devices to sense when people are changing state (e.g. entering a manic or a deeply depressed phase), for instance by noticing a change in voice pattern or usage frequency, or facial tension. It may also become possible to measure physical evidence of levels of distress and suffering, such as changes in hormones or adrenalin in blood, and changes in brain activity. Apps may also be able to predict high stress situations, based on location, time, activity (e.g. purchasing of alcohol) and nearby presence of high risk people. The technology could then send calming messages to patients, automatically alert carers and even automatically administer meds. [15]

There are different technologies that are used in the mental health field over the past 30 years. "Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device's built-in sensors to collect information on a user's typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs" (Technology and the Future of Mental Health Treatment, n.d.). This connects to Quan-Haase reading about surveillance. The use of a mobile app that knows people behavior has private information about the people who use it. The people are being watched by the app creator or company. Functional view argues that societies, in order to operate effectively, require some element of security and safety. To achieve these goals, personal information in surveillance are only for a degree, not of kind. "This form of surveillance is harmless since third-party companies are primarily interested in aggregate data and will use this information for the purpose of developing and marketing better products, which will benefit consumers in the long run". [16] (Quan-Haase, 2016, p. 222-223). There are many pros of using mental health app such as it is convenience, lower cost, and 24-hour service.

Technology companies are developing mobile-based artificial intelligence chatbot applications that use evidence-based techniques, such as cognitive behavioral therapy (CBT), to provide early intervention to support mental health and emotional well-being challenges. [17] Artificial intelligence (AI) text-based conversational applications delivered securely and privately over mobile devices have the ability to scale globally and offer contextual and always-available support. A recent real world data evaluation study, [18] published in the open access journal JMIR mHealth & uHealth, that used an AI-based emotionally intelligent mobile chatbot app, Wysa, identified a significantly higher average improvement in symptoms of depression and a higher proportion of positive in-app experience among the more engaged users of the app as compared to the less engaged users.

On 15 June 2020, the Food and Drug Administration approved the first video game treatment, a game for children aged 8–12 with certain types of ADHD called EndeavorRx . It can be downloaded with a prescription onto a mobile device, and is intended for use in tandem with other treatments. Patients play it for 30 minutes a day, 5 days a week, over a month-long treatment plan. [19]

Technology and cognitive behavioral therapy

The development of mobile phone apps using cognitive behavioral therapy (CBT) has an increasing research area. [20] Using the idea of cognitive behavioral therapy (CBT) apps, self-rated mental health (SRMH) situations can be implemented into these apps and used as information before seeing a professional. Recent research done with self-rated mental health (SRMH) involves survey research which is conducted by with a question that asks respondents to rate their overall mental or emotional health from poor to excellent. [21] The research found with SRMH showed that 62% of people with a mental health problem rated themselves as having positive mental health. The respondents who rated their mental health as good when compared to those with poor mental health, had 30% lower odds of having a mental health problem at a follow-up. This research showcased that without treatment, people with a mental health problem did better if they perceived their mental health in a positive way by declaring a good overall mental or emotional health. [21]

While studies have investigated the clinical efficacy of remote-, internet- and chatbot-based therapy, there are other factors, such as enjoyment and smoothness, that are important for evaluating therapy sessions. Research published in 2019 reported a comparative study of therapy sessions following the interaction of 10 participants with human therapists versus a chatbot (simulated using a Wizard of Oz protocol), finding evidence to suggest that when compared against a human therapist control, participants find chatbot-provided therapy less useful, less enjoyable, and their conversations less smooth (a key dimension of a positively-regarded therapy session). [22]

A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an app that helps people notice their "unhelpful fast-thinking" might be more effective for treating paranoia in people with psychosis than CBT alone. [23] [24]

Effects and impact

Economic evaluations

From an economical perspective, digital interventions for mental health conditions seem to be cost-effective compared to no intervention or non-therapeutic responses such as monitoring. However, when compared to in-person therapy or medication their added value is currently uncertain. [25]

There is uncertainty around the ethical and legal implications of digital technologies in the mental health context, including the use of artificial intelligence, machine learning, deep learning, and other forms of automation. Ethical and legal issues tend to not be explicitly addressed in empirical studies on algorithmic and data-driven technologies in mental health initiatives. [26] Concerns have been raised about the near-complete lack of involvement of mental health service users, the scant consideration of algorithmic accountability, and the potential for overmedicalization and techno-solutionism. [26]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

<span class="mw-page-title-main">Telepsychiatry</span> Mental-health care by telecommunication

Telepsychiatry or telemental health refers to the use of telecommunications technology to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.

mHealth Medicine and public health supported by mobile devices

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and personal digital assistants (PDAs), and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery/sharing of healthcare information for practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care as well as training and collaboration of health workers.

Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to improve sleep habits and behaviors by identifying and changing the thoughts and the behaviors that affect the ability of a person to sleep or sleep well.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

In psychology, relationship obsessive–compulsive disorder (ROCD) is a form of obsessive–compulsive disorder focusing on close or intimate relationships. Such obsessions can become extremely distressing and debilitating, having negative impacts on relationships functioning.

<span class="mw-page-title-main">Activity tracker</span> Device or application for monitoring fitness

An activity tracker involves the practice of measuring and collecting data on an individual's physical and psychological activity to keep track and maintain documentation regarding their health and wellness. Used for many groups even animals as seen in collar-mounted activity trackers for dogs. A lot of the data is collected through wearable technology such as wristbands which sync with mobile apps through Apple and Samsung. As daily technologies such as phones and computers have been innovated, it paved the way for such wearable tracking technologies to be advanced. There are a variety of stakeholders involved in the usage of activity tracking through wearable technology and mobile health apps, knowing how much they track ranging from fitness, mood, sleep, water intake, medicine usage, sexual activity, menstruation, and potential diseases raises the concern on privacy given a lot of data is collected and analyzed. Through many studies that have been reviewed, data on the various demographics and goals these technologies are used provide more insight into their purposes.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

Mindfulness and technology is a movement in research and design, that encourages the user to become aware of the present moment, rather than losing oneself in a technological device. This field encompasses multidisciplinary participation between design, psychology, computer science, and religion. Mindfulness stems from Buddhist meditation practices and refers to the awareness that arises through paying attention on purpose in the present moment, and in a non-judgmental mindset. In the field of Human-Computer Interaction, research is being done on Techno-spirituality — the study of how technology can facilitate feelings of awe, wonder, transcendence, and mindfulness and on Slow design, which facilitates self-reflection. The excessive use of personal devices, such as smartphones and laptops, can lead to the deterioration of mental and physical health. This area focuses on redesigning and creating technology to improve the wellbeing of its users.

Christopher James Alfred Granville Fairburn is a British psychiatrist and researcher. He is Emeritus Professor of Psychiatry at the University of Oxford. He is known for his research on the development, evaluation and dissemination of psychological treatments, especially for eating disorders.

Digital therapeutics, a subset of digital health, are evidence-based therapeutic interventions driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. Digital therapeutic companies should publish trial results inclusive of clinically meaningful outcomes in peer-reviewed journals. The treatment relies on behavioral and lifestyle changes usually spurred by a collection of digital impetuses. Because of the digital nature of the methodology, data can be collected and analyzed as both a progress report and a preventative measure. Treatments are being developed for the prevention and management of a wide variety of diseases and conditions, including type 1 & type II diabetes, congestive heart failure, obesity, Alzheimer's disease, dementia, asthma, substance abuse, ADHD, hypertension, anxiety, depression, and several others. Digital therapeutics often employ strategies rooted in cognitive behavioral therapy.

Mental health informatics is a branch of health or clinical informatics focused on the use of information technology (IT) and information to improve mental health. Like health informatics, mental health informatics is a multidisciplinary field that promotes care delivery, research and education as well as the technology and methodologies required to implement it.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

<span class="mw-page-title-main">Alison Darcy</span> Psychologist and technologist

Alison Darcy is a research psychologist and technologist. She is the Founder and President of Woebot Health, a company which provides digital therapeutics and behavioural health products.

References

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