Across the globe, most individuals with mental health conditions do not receive treatment, let alone evidence-based care. Barriers to effective treatment include a shortage of adequately trained mental health professionals, the time and costs associated with therapy, and stigma surrounding mental health issues.
Researchers are hopeful that new developments in technology can help address these barriers by delivering therapeutic interventions using computers or smartphones. Advances include mental health apps, text-based treatment, computer-assisted therapy, and even the use of artificial intelligence (AI) to deliver treatments. The developers of these new technologies hope to make therapy more convenient, accessible, and affordable.
The Importance of Research
However, there is also reason to be cautious. Most of the mental health apps currently available do not have a robust research base supporting their efficacy, and there is very little oversight to ensure users are getting the help they need. As with many new technological developments, by the time randomized controlled trials have been conducted, peer-reviewed, and published, the technology has become obsolete, or replaced by something newer and untested. It is difficult for consumers and professionals to know whether new technology is helping, or whether it might actually be hurting users.
Computer-Assisted Cognitive Behavior Therapy
One new development, which has been tested, is Computer-assisted Cognitive Behavior Therapy (CCBT) (Wright et al., 2019). CCBT teaches clients how to evaluate thoughts, engage in behavioral activation, and utilize basic coping strategies and other core CBT skills. Clinician-guided CCBT includes limited clinician contact via telephone or email in addition to the computer-based components. Research demonstrates that the addition of clinician support to CCBT leads to better outcomes for depressed clients than CCBT alone, while still decreasing overall contact between the clinician and patient, thus decreasing costs and creating more time for the clinician to treat other clients. CCBT has great promise for helping clients in areas where there is a lack of trained clinicians, or in settings where clinicians are overwhelmed by large caseloads.
The Role of Human Guidance
A recent meta-analysis by Koelen et al. (2022) provided additional support for the idea that, in general, internet or text-based therapy with the addition of human guidance is more efficacious than computer-based treatment alone. Human guidance could include simple technical support; feedback on assignments; encouragement; or intervention in the case of crisis. The analysis revealed that the addition of human guidance led to increased adherence to the therapies, and that regular, ongoing human guidance was more effective than human guidance provided only upon patient request. Even with the addition of human support, these therapies still increase access to services and decrease costs; they decrease or eliminate travel time for individuals to and from appointments; and they allow individuals to receive services in their homes, providing privacy for those who may feel stigmatized when seeking treatment.
The ongoing need for human support to augment computer- and smartphone-based treatment has led to the development of AI-delivered therapy. One recent study (Mehta, et al., 2021) examined the app Youper, which uses AI to guide users through the use of interventions, many of them adapted from CBT (i.e. cognitive restructuring, emotion regulation, and goal setting). The researchers found that the users of the app reported decreased symptoms of depression and anxiety. In addition, users were likely to continue using the app for several weeks, and the majority rated the app highly. Smartphone apps that utilize AI make mental health services accessible anywhere, any time, and warrant further study.
Beck Institute encourages the continued development of new technologies that advance mental health treatment and make it more accessible and affordable for individuals everywhere. We urge researchers to examine these technologies using randomized controlled trials to ensure that they are effective, and call for increased oversight to identify individuals who are at risk of hurting themselves or others, and to ensure that individuals are getting evidence-based care in a manner most suited to their needs.
References:
Wright, J. H., Owen, J. J., Richards, D., Eells, T. D., Richardson, T., Brown, G. K., & Thase, M. E. (2019). Computer-assisted cognitive-behavior therapy for depression: a systematic review and meta-analysis. The Journal of clinical psychiatry, 80(2), 3573.
Koelen, J. A., Vonk, A., Klein, A., de Koning, L., Vonk, P., de Vet, S., & Wiers, R. (2022). Man vs. machine: A meta-analysis on the added value of human support in text-based internet treatments (“e-therapy”) for mental disorders. Clinical psychology review, 96, 102179. Mehta, A., Niles, A. N., Vargas, J. H., Marafon, T.,
Couto, D. D., & Gross, J. J. (2021). Acceptability and effectiveness of artificial intelligence therapy for anxiety and depression (Youper): Longitudinal observational study. Journal of medical Internet research, 23(6), e26771.