Technology Therapies — 28 June 2012

Online communities and computerized cognitive behavioral therapy can help break the stigma of depression, extend providers, and reduce overmedication, report says.

There are many reasons why people don’t seek treatment for mild to moderate depression, including social stigmas, lack of insurance coverage for mental health, unwillingness to try psychoactive medications, and doubt about whether a primary care physician is the right person to approach with emotional concerns. Technology–specifically what is being called computer-based cognitive therapy–may help break down some of those barriers.

“Computer-based cognitive behavioral therapy (CCBT) cost-effectively leverages the Internet for coaching patterns in self-driven or provider-assisted programs. Technological advances have enabled computer systems designed to replicate aspects of cognitive behavior therapy for a growing range of mental health issues,” said a new California HealthCare Foundation reportabout Web-based care for mental health.

The report, authored by health economist Jane Sarasohn-Kahn, discusses how this technology, often called e-therapy or tele-mental health, offers a low-cost, comfortable alternative to traditional psychotherapy and can extend options into underserved rural areas and inner cities.

Dr. Peter Yellowlees, a psychiatrist at the University of California, Davis, who researches telehealth, said in the report that videoconferencing can make psychotherapy more appealing to some patients, helping to overcome any stigma associated with depression. “Video can offer a bit of extra space,” he is quoted as saying. “People are often more honest on computers than face-to-face. If you want to ask a difficult question, it can be better to do it on a computer, compared with being face-to-face with paper and pencil.”

The United States and France have the highest rates of depression in the world, according to World Health Organization data cited in the report, yet only a third of people in the U.S. with depression ever seek help, according to the report. Regardless of how the Supreme Court rules on the Patient Protection and Affordable Care Act, “we are going to have to deal with mental health,” Sarasohn-Kahn told InformationWeek Healthcare.

According to the study, less than half of Americans taking antidepressants have seen a mental health professional in the past year, and sometimes people whose depression is not severe might need therapy more than medications. “Prescribe computer-based therapy before medicating for mild to moderate depression,” Sarasohn-Kahn advised.

“In addition to online videoconferencing, patients looking for help with mild to moderate depression and anxiety might be able to receive services through self-administered computer-based cognitive behavioral therapy (CCBT), mobile health apps, therapy-oriented games, virtual reality, and online social networks,” Sarasohn-Kahn wrote in a post on her Health Populi blog.

Gaming, in particular, can help remove the stigma for children and adolescents. “Video therapy might also be a ‘safe space’ for discussing difficult or painful issues that could facilitate rapport,” Sarasohn-Kahn said in an interview.

She noted that 80% of primary care physicians in the United Kingdom use online behavioral therapy site Beating the Bluesto teach coping skills as an initial therapy before turning to antidepressants, and have for several years. “It’s not new,” according to Sarasohn-Kahn.

Seven in 10 patients who were recommended for Beating the Blues did not need in-person psychotherapy, the British National Health Service found. Thanks to this history, the system has been exported to several other countries, including in the U.S. at the University of Pittsburgh Medical Center, and it is being evaluated by the U.S. Department of Veterans Affairs.

Another program, Eliza, employs automated voice-response technology in a depression-screening tool for health plans and employee assistance programs.

In the social arena, PatientsLikeMe, which started as a community for people with neurological disorders, developed a “mood map” because so many people with conditions like amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and multiple sclerosis also show signs of depression.  “[PatientsLikeMe] captures far more than the data recorded in purely medical environments–granular aspects of daily living that are critical to understanding the context of a person’s mood,” the report explained.

Technology such as this can “scale up quickly,” according to Sarasohn-Kahn. This makes it useful for cash-strapped state Medicaid programs and federally qualified health centers. “A growing number of therapists are seeing this as a revenue source,” she added.

As first appeared in Information Week


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