Digital Mental Health Flashcards
Are digital activities popular?
Yes - they are everywhere
UK adults spend on average 24 hours a week online
90% of UK households have internet access
89% are current internet users - 86% daily users
77% of adults access internet on the go - 98% 16-24 and 29% 65+
How are digital technologies changing mental health care?
Digital front door - moving primary care contacts to be digital first - first thing you should do is go online
Simple digital transactions - booking appointments and getting prescriptions online
Seeking health info-advice online
Professional and peer support online
What are some of the problems with seeking help online?
Sometimes people may wrongly self-diagnose by using the internet
How can people be assessed online?
Online assessment using standardised questionnaires
Assessment and monitoring via wearables and real time self-report - techniques online which help with stressors
Are digitally support therapies recommended?
Widespread in the NHS primary care
Recommended by NICE as first treatment for mild-moderate depression, panic and generalised anxiety disorder
Digistised computerised CBT were first recommended for depression 10 years ago - this isn’t a new idea: access for all be around for a long time and CCBT
What is CCBT recommended for?
Low intensity interventions for depression, panic disorder and generalised anxiety disorder
Not recommended for PTSD, OCD and social phobia
What is the history of computer therapists?
1970’s - early work published, thinking common computer therapy should focus on systematic densentisation for low phobias and anxiety
What is systematic desensitisation?
Focus on the most feared situation someone could tolerate and working down to something which is completely intolerable
Offer stimuli through exposure technology - paired with a relaxation technique
Press one key when they feel uncomfortable and another when comfortable, go through a hierarchy, when they feel ready, exposure along hierarchy can continue
Do you need interaction with a therapist for SD to work?
No - it does not require interaction with a therapist to be successful - the live therapist in not required
some evidence computer therapy is better, could be because place of agency is within the individual, not the therpapist doing anything
Is virtual reality exposure therapy good?
Been shown to be just as effective as when the actual object is there - can be set up for a variety of fears
For anxiety, meta-analysis of randomised control trials find no difference between VR experiences compared to vivo exposure therapy
What are the types of digital delivered / supported therapies?
Unguided digital interventions Guided digital interventions Blended digital/face to face interventions Real time online therapies Asynchronous online therapies Digitally augmented therapies
What are guided digital interventions?
Minimal support - phone and email then once a week have a check in call about program: these are quite common in IAPT services, adding a small amount of support can do a lot to increase engagement as they know they have to go back
What are blended digital/face to face interventions?
50/50 split between online and seeing a therapist - work might be divided so do general things on the computer, but specific things delivered by a therapist
What are real-time online therapies?
Video conference, webinar
What are asynchronous online therapies?
Therapy conducted by email/messaging
What are digitally augmented therapies?
SMS, email, apps etc
What are the techniques / structure used in CCBT?
Many based on the idea of CBT Modern programs guide the user through the important ingredients of therapy in a self help, multi media format, such as: psychoeducation assessment of current problems with feedback and change monitoring action plans and goals guided change techniques homework narrator or therapist communication by email
What are examples of websites that the NHS recommend?
Beating the blues Living life to the full Mood gym Kleur je leven Mindful mood balance
What do these websites include?
Behavioural activation - case studies to bring examples, look at people experiencing similar things
Include assessment, feedback, monitoring, guided discovery, review
Get a reminder of what has been done in the session - paper copies you can look back on to support on going learning
What did proudfoot et al 2004 / Mccrone et al find in his RCT?
Looked at beating the blues vs usual care in the NHS
Gp patients aged 18-75 with depression/anxiety, with or without medication
276 participants from primary care
outcome: beck depression inventory, beck anxiety inventory, work and social adjustment scale, health service usage
Pre, post, 1 month, 3 month and 6 month follow up
Results:
Pre - experience was equal
Beating the blues offers clinical experience over and above treatment as usual
2/3rd completed all 8 sessions
Benefits were maintained to 6 month post treatment
Standard treatment did get better but not as good
Cost ratio demonstrating that beating the blues is a cost-effective intervention for depression primary care
What did Andrews et al 2010 find in his meta-analysis of CCBT RCTs?
A lot more studies since Proudfoot
22 randomised control trials which had looked at CCBT for major depressive disorder, panic and generalised anxiety disorder
Large effect size compared to control
What has guided self-help versus face to face CBT found? Cuipers et al 2010
Comparing computerised CBT and face to face CBT of the same kind
Overall, no difference between guided self-help and face to face CBT
Do digital therapies work?
They support well-being and build resilience to clinical interventions
They have shown to be a less intensive, cost-effective way to deliver empirically validated treatments for a variety of psychological problems
Are apps recommended?
Most NHS trusts also recommended apps to support mental health, NHS apps library offers a range of apps
wellness apps - headspace (25 million downloads across 190 countries, > 1 million subscribers and Calm
Chat-bots - using language processing capabilities in computing to generate conversations through messaging (can be done with robots)
Is there evidence for smart-phone based interventions?
Meta-analysis of research trials support the effectiveness of smartphone based mental health interventions to reduce symptoms
anxiety 9 RCTs
Depression 18 RCTs
What are examples of local IAPT digital initiatives?
Silver cloud - computerised CBT
IESO - email therapies
Mind district platform offering blended care approach for children and young people services
Skype therapies
Digital workbook for STEPPS in development
What are the advantages of using Digital technology?
Increase access and choice of effective, evidence based practise for some people, who wouldn’t normally access it
Increase flexibility in location and pace of engagement - can do it from work, whenever you want
Increase confidentiality / reduce stigma
Offering up to date and consistent information and intervention
Increase self-efficacy, mastery and learned resources
Cost-effectiveness
What are the disadvantages of using digital technology?
Digital exclusion and inaccessibility - who is at risk? Ensure offline services are also available for people who don’t want to use them
Scope and solutions - what range of issues can digital tools support / what kinds of interventions can be meaningfully translated digitally?
Absence of human/therapeutic relationship - could be risks with not having it
Engagement, motivation and need for support - added benefit from brief phone or email support, dropout rates can be high for unsupported digital interventions, but support therapies similar to face-to face - people drop out more from non-guided help
Are they positive about it?
Research suggests users are more positive about digital interventions than therapists
Potential users indicate positive expectations and high treatment credibility for CCBT
Are therapists hopeful?
Therapists may be less hopeful about CCBT than their clients - therapists are scared about this, computers doing their job, need education about it
What are the future opportunities for digital mental health?
Increasing reach and impact in the NHS
Enhancing services through user-centred design
Increasing engagement and impact through gamification
Global dissemination of evidence-based interventions
Big data/predictive analytics
Digital training for healthcare staff
