Digital Therapy In an Analog World

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Digital Therapy In an Analog World

When you have a bad day, is it a touch of the blues or something more? Maybe the pressure at work is getting to you. Despite the good weather, you’re stuck in a bad mood, and you feel paralyzed at the thought of digging yourself out of this hole.

In the past, you’d see a psychiatrist, but today, a host of digital tools can help you diagnose and treat the issues. You can turn to an app to help track your mood, or consult with a “virtual therapist” to analyze your body language and tone of voice. But are these really practical solutions?

Treating the problem is often a long process. To get a diagnosis, you have to lie on a couch for hours as a therapist explores your family history, disappointments and life decisions. That practice, called “deep inquiry,” has its roots in the Stoic philosophers of ancient Greece. But in the early 20th century, Sigmund Freud formulated the “couch time” format, a psychoanalysis approach that uses intense one-on-one or small group sessions to treat disorders. Over time, though, behavioral modification and cognitive psychology replaced Freud’s method, but therapy has largely remained the same… until now.

The traditional approach — and the sense of cajoling and scolding that comes with it — is largely ineffective, an American Journal of Preventive Medicine study found. Real change, it says, often comes from collaborative discussion, an idea called “motivational interviewing.” That technique, which had found success in substance abuse and addiction programs in the ’80s, is a growing trend in the industry.

It’s a simple concept: take counseling tactics for addicts, and adapt it to manage chronic-diseases — to stop smoking, lose weight and even fight depression. Instead of a therapist diagnosing and telling you what medication and treatments to take, doctors ask what changes and bite-sized goals you’re willing to make. Why? Because the first step has to come from you, not the doctor.

“When people are struggling, they don’t like to be told what to do, and they dislike being labeled and blamed,” Dr. Stephen Rollnick, professor of healthcare communication at Cardiff University, told the Wall Street Journal. Motivational interviewing puts patients in the driver’s seat, and that makes digital tools an ideal solution for that personalized approach. In the near future, therapy may not come from a Freudian one-on-one session, but from your iPhone.

Keeping Moods in Check

Simple apps are helping to keep emotions on an even keel. They work by collecting and analyzing data about your activities, then alerting you of any abnormalities. “Mobilyze,” developed as part of a research trial at Northwestern’s School of Medicine, monitors your location and social interactions and alerts you of signs for depression. If you start missing activities you enjoy — like your book club or your child’s soccer match, for example — it’ll bring it to your attention.

In 2010, the Department of Defense unveiled an app that tracks the emotions of soldiers after combat deployment. Dubbed T2, after the National Center for Telehealth and Technology, the app records and reviews behavioral changes — such as anxiety, depression and stress — which can be sent to doctors to diagnose more severe cases.

“An essential part of therapy is the ability to understand a patient’s behavior,” Dr. Julie Kinn, a T2 psychologist, said in a statement. “The best way to do this is to record it as it happens over an extended period. When that information is collected after the fact, especially about moods, it tends to be inaccurate.”

Meanwhile, MoodKit, developed by a pair of clinical psychologists, puts tools into your own hands. The app helps you to identify and change unhealthy thoughts, rate and chart your state of mind and record related events in a journal. It then uses the power of cognitive-therapy techniques to recommend over 200 examples of mood-boosting activities to help you improve your self-image.

Digital Diagnosis

Apps are a natural fit with a patient-centered, self-driven approach, but if you need more support, online options can step in. SimSensei, developed by the University of Southern California’s Institute for Creative Technologies, is a virtual therapist. Powered by the Kinect’s motion recognition technology, an animated avatar asks you questions while analyzing non-verbal cues — like body language, fidgeting and facial expressions — to help diagnose anxiety. The software is still in the early test phase, but researchers say it’s able to diagnose depression with 90 percent accuracy.

Another virtual coach, “Shelley,” developed by Healthwise, a nonprofit that designs corporate patient-education materials, uses conversation to help you make decisions and change behavior. Shelley’s soothing voice counsels you about weight and sleep problems, among other patterns, which can be used in a maintenance program. Since Shelley is virtual, she has all the time to listen to you, Healthwise CEO Donald Kemper told the Wall Street Journal, giving you empathy and helping you clarify the changes you need to make.

For a digital twist on a traditional approach, start-up Talktala hired certified therapists to hold one-to-one and group sessions online. Common topics like “our relationship lost its spark” and “I’m losing control over my drinking” start at $10 for a 45- to 90-minute session via video, audio or chat. By holding sessions over the Internet, Talktala is lowering the cost of traditional counseling, so if you don’t have a history of mental issues, but are having marital problems, for example, you can take part in a group sessions, and if needed, move to one-on-one counseling.

Co-founder Oren Frank told Mashable the service is ideal for people who say, “I don’t know if I need therapy, but I could certainly talk to someone.” He added that it’s also an affordable way to see different therapist styles to find one that best fits you. The service adds an extra level of privacy, too. Of course, there’s the convenience of holding sessions at home, but if you don’t want the neighbors knowing you in therapy, you can also choose a counselor across the country.

Those benefits are fueling a growing number of traditional organizations go online as well. Canada’s Thunder Bay Counseling Centre, Children’s Centre Thunder Bay and the Catholic Family Development Centre, for example, banded together to launch an online part to their counseling service. The service, based confidential secure e-mail exchanges with a therapist, creates a transcript of the sessions for your records. Meanwhile, across the pond, U.K.-based “Mootu,” offers one-on-one therapy with over a hundred professional counselors and psychotherapists via Skype video.

Prison Systems

Perhaps nowhere is there a greater need for counseling than in prisons, and correctional facilities are beginning to adopt digital tools to cut costs and improve mental health services. Similar to general counseling, these programs use face-to-face consultations over mobile devices to minimizing the risks for on-site visits, inmate transports and disruption to prison routines. Wind Currents, one of the providers of these systems, estimates, on average, a state can save $30,000 to $40,000 each month with its system, which includes a hosted VoIP platform, video software and special videophones.

Local jails are exploring digital tools, too — but to cut costs. For example, according to the Pioneer Press, Minnesota’s Dakota County Jail tested a video service using Skype, allowing families to visit inmates without taking their children to jail. The program, offered through TurnKey Corrections, also monitors calls for inappropriate behavior. Inmates pay around 35 cents a minute, which generates revenue for the county, reducing the need for taxpayer dollars. After $12,000 in equipment and installation costs, Dakota County officials estimate the program generated over $2,600 in revenue. TurnKey is already in jails across Oregon, Idaho, North Dakota, Indiana and Missouri.

A Band-Aid on a Broken Neck

The idea of digital therapy is appealing: you can talk in the privacy of your own home and you pay a fraction of the cost of traditional counseling. But if you suffer from more severe issues, it’s not a cure. Smartphone apps, online platforms and computerized monitoring systems can give you support, but these “brave new world” tools are still superficial response to a more complicated problem.

Developers of SimSensei and Shelley stress their avatars are “coaches” and not “licensed therapists,” but mental health advocates worry insurance companies are starting to lean heavily on these tools to save money and justify funding cuts for mental health services.

But the appeal and shifting demand for self-monitoring products is already here. In many ways, we all benefit from playing a more active role in our own mental health, but it’s important to remember: digital tools complement, not replace, traditional services. Depression and anxiety, among other mental issues, are serious conditions, and no app or tech solutions can substitute for insightful empathy, a sympathetic ear or just old-fashioned time and patience in unraveling often deep-rooted and crippling patterns — at least for now.

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Modern Health

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