Digital Mental Health Flashcards
How are digital technologies everywhere?
UK adults spend on average 24 hours a week online. 90% of UK households have internet access (98% of these have fixed broadband). 89% UK adults are current internet users - 86% daily users, 77% adults accessed internet ‘on the go’ - 98% 16-24a, 39% 65+. ‘On the go’ is for: Communication & connection, shopping and services, news and entertainment, banking and healthcare.
How are digital technologies changing mental healthcare?
Digital front door – www.NHS.uk etc – trying to move all primary care contact to be digital first, e.g. digital consultation. Simple digital transactions – appointments, prescriptions. Seeking health information/advice online (e.g. Moodzone). Professional and peer support online.
How is digital changing the healthcare experience?
Online assessment using standardised questionnaires – been shown to have good specificity. Used at beginning to assess difficulties, and used throughout treatment to monitor the ongoing trajectory of experience of symptoms and treatment. Assessment and monitoring via wearables and real time self-report - opportunity for just in time interventions.
What are digitally delivered and digital supported therapies?
Widespread in NHS primary care and psychological therapies services. Recommended by National Institute for Health and Care Excellence (NICE) as first line treatment for mild-moderate depression, panic and generalised anxiety disorder. Computer therapy – an NHS aspiration available to everyone. Computerised CBT been quite a lot of research assessing efficacy, cost etc. NICE indicated “low intensity” interventions for common mental health problems for depression, panic disorder, GAD, OCD. Not for PTSD and social phobia.
What is the history of computer therapies?
Highlight stimuli that is most fearful, and working down this spectrum. Identify what they would like to be able to tolerate whilst identifying what they are fearful of. Pairs this with a relaxation strategy which the person is taught. Select a key to indicate they are comfortable, press an uncomfortable key if the stimuli becomes too stressful for them. Exposure along the hierarchy continues when click the comfortable key.
What is systematic desensitisation?
“does not appear to require interaction with a therapist in order to be successful” (Bloom, 1992; p.183) – computing intervention just as effective as when working with therapist. “the live therapist is not just an unnecessary luxury, but a hindrance” (Lang et al., 1970) – person has done it for themselves.
What is virtual reality exposure therapy?
Widely used, especially when more cost effective, e.g. to combat fear of flying. Shown to be just as effective and have as long-lasting effect as interventions taking place in the location of fear.
What are digitally delivered/supported therapies?
Unguided digital interventions - programmes written by clinical psychologists/behavioural therapies with the option of interaction, but accessed uniquely by the user. Guided interventions (“minimal” support - face-to-face, phone, email), e.g. 10 mins a week, but working on the programme independently by themselves- online clinics, adding a small amount of support can do a lot to increase engagement. Blended digital/face to face interventions – moving up the human input, 50/50 interaction and independent work. Real-time online therapies – video conference, ‘webinar’ etc. Helpful for those who cannot attend a clinic due to physical issues. Asynchronous online therapies – email/messaging. Digitally augmented therapies - + SMS, email, apps etc. Seeing therapist in traditional way, but work is supported by digital ways. Modern programs guide the user through the important ingredients of therapy (usually CBT), in a self-help, multi-media format, e.g. Psycho-education. Assessment of current problems with feedback and change monitoring. Action plans and goals. Guided change techniques (e.g. behavioural activation, evaluating negative automatic thoughts, problem solving). Homework – take what was learned and integrate it into daily life. Narrator or ‘therapist’ and case examples. E.g. Beating the blues, Behavioural activation – generate a sense of shared goals, include assessment feedback etc., bring warmth and empathy to the programme. Programme generates weekly projects for the individual like you would get in face-to-face therapy. Weekly reports noting and particular upset for the individual or any suicidal thoughts, clinician would be looking at this report each week, and any suicidal thoughts noted would be given advice on how they can be helped.
Are digital CBT programmes effective?
They are accessible for everyone, help users make sense of their problem. Lead to a reduction in difficulties and improved well-being, sustained in the longer term.
Are digital CBT programmes effective? - randomised controlled trial: beating the blues vs. usual care in NHS primary care
¥ GP patients aged 18-75 with depression and/or anxiety, with or without antidepressant medication
¥ 276 participants from 12 primary care practices
¥ Outcome measures:
¥ 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
At baseline the level of depression in both group were equal and in the moderate range. After 8 weeks the ones using beating the blues reported much lower scores than those in primary care services – those in NHS did get better in time, but not as quickly as beating the blues. Can see this effect six months later on. Suggests efficacy of computerised CBT for depression.
What is a summary of RCT outcomes? (Beating the Blues vs. usual health care in NHS)
λ Beating the Blues offers clinical benefits over and above treatment at usual
λ 2/3rds users complete all 8 sessions
λ Intent-to-treat analysis shows that benefits are maintained to 6-months post treatment
λ Outcome: cost ratios demonstrate that Beating the Blues is a cost-effective intervention for depression primary care
λ Lost employment costs are significantly lower following Beating the Blues than treatment as usual
Do digital therapies work?
They work by supporting well-being and building resilience to clinical intervention. There are a large number of papers questioning this conclusion, and finding smaller effects – of course the effect is going to be different for different people. Might offer a good first point of contact, effective for some people. Most NHS mental health trusts also recommend apps to support mental health. Wellness apps include headspace and calm.
What is evidence base for smartphone-based mental health interventions?
¥ Meta-analyses of research trials support the effectiveness of smartphone-based mental health interventions to reduce symptoms of anxiety and depression
¥ Anxiety (9 RCTs, N=1837)
¥ Depression (18 RCTs, N=3414)
What are local IAPT Digital Initiatives?
¥ SilverCloud – computerised CBT.
¥ IESO – email therapies.
¥ MindDistrict platform offering blended care approach for Children and Young people’s services.
¥ Skype therapies.
¥ Digital workbook for STEPPS in development.
What are advantages and opportunities involved in digital mental health?
¥ Increase access and choice of effective, evidence based practice – seem to work in some cases for some people, maybe for those who wouldn’t otherwise access psychological help.
¥ Increase flexibility in location and pacing of engagement – face-to-face is a fixed weekly meeting, so online gives more flexibility around your life.
¥ Increase confidentiality / reduce stigma.
¥ Offering up to date and consistent information and intervention – can take NHS services quite a long time to implement new evidence.
¥ Increase self-efficacy, mastery and learned-resourcefulness – specific advantages for doing it yourself, taking control of own progress.
¥ Cost-effectiveness.
¥ Potential users indicate positive expectancies and high treatment credibility for Computerised CBT programs (e.g. Cavanagh et al., 2009; Grist, 2014).
