Ten years ago, smartphone apps didn’t even exist.
Technology offers ever more ways to deliver health care without patients actually visiting a doctor. That’s especially true with mental health care, since physical examinations are not usually needed.
Researchers are just starting to examine whether or not these technological approaches — which may be the future of mental health care — are actually effective.
In a recent article published in World Psychiatry, the journal of the World Psychiatric Association, Dr. Elias Aboujaoude of Stanford University and colleagues rounded up the current research on so-called “telemental health” care — and found reasons to be hopeful as well as wary.
Even before there were apps that would ask you how you feel, automated psychotherapy was available through desktop software and interactive voice response telephone systems beginning in the 1980s. These programs were designed so patients could self-diagnose and set personal treatment goals while getting standardised cognitive behavioural therapy — all from a computer, no therapist involved.
Today, such programs are also available via the internet, and some also involve communication with a real therapist through email, text message, or videoconferencing.
Smartphone apps provide another, rapidly growing platform for remote mental health care. Some apps repeatedly prompt users to record their moods and activities, which can help them keep track of their symptoms and be more self-aware. Others combine self-monitoring with cognitive behavioural therapy like that in the old software programs.
A major advantage of delivering mental health care online or via a smartphone app, Aboujaoude and his coauthors write, is that it gives many more people access to care. People who live in areas without many mental health care providers, whose disorder prevents them from leaving the house, or who are deterred from seeking treatment by the stigma attached to mental illness treatment facilities may find it easier to get care through an app or online. Also, the care itself may be more cost-efficient and affordable since it doesn’t require the expense of keeping an office.
However, there are concerns that telemental health programs don’t sufficiently support patients and fail to give them a deep understanding of their conditions. Patients also must already have certain computer skills to receive care, and — perhaps most importantly — this type of care is so new we’re barely starting to get a sense of its efficacy. Worst-case scenario, it might not work at all.
Does it work?
Studies comparing software-based cognitive behavioural therapy programs to traditional CBT have shown that the tech-based care — which includes therapy with and without a real therapist in the loop — was about as good at alleviating depressive symptoms post-treatment, though improvements lagged behind traditional care at long-term follow-ups. Patients getting therapy through technology were also more likely to drop out of treatment than patients getting traditional therapy.
Overall, research studies “support a role for these interventions in modern psychotherapy delivery,” Aboujaoude and his coauthors write. After all, they may be the only option certain patients have.
As for smartphone apps, researchers think that they can be beneficial because they allow users to log how they feel in real-time, gathering more accurate data than that stored in memory. Research has backed this up: One study of self-monitoring apps found they help users increase their self-awareness and improve depressive symptoms.
However, there’s still not much research about the efficacy of smartphone apps for mental health, and Aboujaoude and his coauthors say documented dropout rates and user fatigue are “serious limitations.”
That said, the amount of medical care administered remotely is only expected to increase in the future. Though there’s not yet much research about how well telemental health care works, what we know so far suggests it could very well be an effective way to reach people who otherwise could not access care.
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