Mobile cognitive therapies gain traction as first-line mental health intervention

Men­tal health apps let you access ther­a­py from your smart­phone (New Scientist):

“Lie down any­where that suits: the world is now your therapist’s couch. A wide range of apps now deliv­er men­tal-health care straight to your smartphone.

With PTSD Coach, users can dis­creet­ly screen them­selves and learn more about the dis­or­der. Mood­notes keeps track of emo­tion­al swings and offers new per­spec­tives on a sit­u­a­tion. And on Talk­space, for a week­ly fee, users can anony­mous­ly text a ther­a­pist any time and receive a response with­in the next few hours.

Next week, anoth­er app in this vein debuts: TruReach Health, offer­ing free lessons in cog­ni­tive behav­iour­al ther­a­py, a treat­ment that teach­es peo­ple to recog­nise and alter neg­a­tive pat­terns in their thoughts or behaviours.

“I love psy­chol­o­gists. If every­one could go and see one, then we’d all be bet­ter off, but that’s just not pos­si­ble,” says Per­ron. “We’re giv­ing some­one a tool because, 99 times out of 100, they just don’t have access to face-to-face therapy.”

Com­put­er-based ther­a­py may not be as out­landish as it may sound. In the UK, the Nation­al Insti­tute for Health and Care Excel­lence rec­om­mends cer­tain cog­ni­tive behav­iour­al ther­a­py pro­grams for peo­ple with mild to mod­er­ate depres­sion or pan­ic and phobia.”

–> To learn more about the tech­nol­o­gy appraisal by the Nation­al Insti­tute for Health and Care Excel­lence: Com­put­erised cog­ni­tive behav­iour ther­a­py for depres­sion and anx­i­ety: Review of Tech­nol­o­gy Appraisal 51. From the tech­nol­o­gy sec­tion (a bit out­dat­ed, but still a great reference):

• 3.1 CCBT is a gener­ic term that is used to refer to a num­ber of meth­ods of deliv­er­ing CBT via an inter­ac­tive com­put­er inter­face. It can be deliv­ered on a per­son­al com­put­er, over the Inter­net or via the tele­phone using inter­ac­tive voice response (IVR) sys­tems. As with CBT, pre-ther­a­py assess­ment is rec­om­mend­ed to ensure that peo­ple are suit­able for ther­a­py, and indi­vid­u­als require ongo­ing mon­i­tor­ing and sup­port. It is sug­gest­ed that a wide range of health or social care per­son­nel could be used to facil­i­tate the ses­sions. Sev­er­al CCBT pack­ages are cur­rent­ly avail­able. Each has been devel­oped for a spe­cif­ic tar­get group or groups and uses dif­fer­ent CBT algo­rithms. The per­son­nel required to imple­ment CCBT can vary from psy­chi­a­trist to prac­tice nurse and the length of ther­a­pist’s time will also vary depend­ing on the programme.
• 3.2 Beat­ing the Blues (Ultra­sis plc) is a CBT-based pack­age for peo­ple with anx­i­ety and/or depres­sion. It con­sists of a 15-minute intro­duc­to­ry video and eight 1‑hour inter­ac­tive com­put­er ses­sions. The ses­sions are usu­al­ly at week­ly inter­vals and are com­plet­ed in the rou­tine care set­ting (that is, GP prac­tice). Home­work projects are com­plet­ed between ses­sions and week­ly progress reports are deliv­ered to the GP or oth­er health­care pro­fes­sion­al at the end of each ses­sion. These progress reports include anx­i­ety and depres­sion rat­ings and report­ed sui­ci­dal­i­ty. No min­i­mum read­ing age is specified.
• 3.3 COPE (ST Solu­tions Ltd) is a CBT-based sys­tem designed to help peo­ple with non-severe depres­sion. COPE was devel­oped as an IVR plus work­book-based sys­tem. It is also avail­able as a net­work ver­sion (net­COPE). It assumes a min­i­mum read­ing age of 11 years. Peo­ple can phone as and when they wish. COPE is a 3‑month pro­gramme with five main treat­ment mod­ules. Sui­cide assess­ment ques­tions are includ­ed and peo­ple are urged to con­tact their doc­tor if sui­ci­dal ideation or plans are experienced.
• 3.4 Over­com­ing Depres­sion: a Five Areas Approach (a Calip­so prod­uct from Media Inno­va­tions Ltd) is a CD-ROM-based CBT sys­tem for peo­ple with depres­sion. The sys­tem con­sists of six ses­sions of about 45–60 min­utes each. The ses­sions are deliv­ered in a mix­ture of text, car­toon illus­tra­tions, ani­ma­tion, inter­ac­tive text, sound and video. It assumes a min­i­mum read­ing age of 9–12 years for all but one mod­ule. The CD-ROM train­ing mate­ri­als sug­gest that a prac­ti­tion­er reviews the per­son­’s use of the disc on three occa­sions over the course. Ses­sions are com­plet­ed on a week­ly basis.
• 3.5 FearFight­er (ST Solu­tions Ltd) is a CBT-based pack­age for pho­bic, pan­ic and anx­i­ety dis­or­ders. FearFight­er was orig­i­nal­ly devel­oped for a stand-alone per­son­al com­put­er (stand­alon­eFF) but was lat­er devel­oped for use on the Inter­net (netFF). It is also avail­able in a short ver­sion for edu­ca­tion­al pur­pos­es (FFe­d­u­ca­tion). FearFight­er assumes a min­i­mum read­ing age of 11 years. FearFight­er is divid­ed into nine steps. Ther­a­pist con­tact for FearFight­er is brief, with 5 min­utes before the ses­sion and up to 15 min­utes after each ses­sion. For netFF, ther­a­pist con­tact is by tele­phone or e‑mail.
• 3.6 BTSteps (ST Solu­tions Ltd) (now called OCFight­er) is designed to help peo­ple with OCD by help­ing them plan and car­ry out CBT on a day-to-day basis. BTSteps was devel­oped as an IVR sys­tem plus work­book. It assumes a min­i­mum read­ing age of 11 years. An Inter­net ver­sion is under devel­op­ment and will obvi­ate the need for IVR and work­book. Helpline sup­port is pro­vid­ed. BTSteps is divid­ed into nine steps.
• 3.7 The avail­abil­i­ty of CCBT pro­grammes per­mits increased treat­ment flex­i­bil­i­ty, espe­cial­ly for indi­vid­u­als who do not want, or who are not suit­able for, drug ther­a­py or who do not wish to inter­act with a ther­a­pist. Com­put­erised deliv­ery of CBT can also be used to sup­port ther­a­pist ses­sions. CCBT may also be of ben­e­fit to indi­vid­u­als with, for exam­ple, ago­ra­pho­bia and social pho­bias because it can be deliv­ered at home. Min­i­mal ther­a­pist appoint­ment time is nec­es­sary for the types of CCBT that can be con­duct­ed at home, and the ther­a­py has 24-hour avail­abil­i­ty for the indi­vid­ual to access at his or her con­ve­nience. CCBT sys­tems can also make it pos­si­ble for users to repeat ses­sions if they wish.

Learn more:

• The men­tal health screen­ings of the future, as hint­ed by Ellie the vir­tu­al therapist
• Info­graph­ic on the Dig­i­tal Brain Health Mar­ket 2012–2020
• 2015 Sharp­Brains Vir­tu­al Sum­mit: Brain Health in the Per­va­sive Neu­rotech­nol­o­gy Era (Novem­ber 17–19th, 2015)