Are online mental aid tests correct?

Psychiatry, Psychosomatics & Psychotherapy

11.11.2019

Digitization & Mental E-Health - Great opportunities meet great challenges

The Swiss professional society FMPP sees its joint responsibility for shaping the health care of the future and deals with the topics of "digitization" and "e-mental health". It would also like to stimulate a future-oriented examination of the development of care approaches.

Our world is currently changing rapidly. Digitization shows an exponential development in many areas of life - including medicine. On the one hand, with this development there are legitimate chances that digitally-supported medicine can support and improve patient care, provided quality-assured offers, and also expand personal possibilities for self-help. In view of the frequency of mental disorders and long waiting times for a therapy place, there is a clear need to strengthen psychotherapeutic care on a broad front.

At the same time, however, digitally-supported medical care also brings with it major challenges and raises complex ethical, social and legal issues. The Swiss professional society FMPP sees its joint responsibility for shaping the health care of the future and is dealing with this topic. It would also like to stimulate a future-oriented examination of the rapid development of care approaches in the field of psychiatry and psychotherapy - also in the specialist public (see: psyCHiatrie - information from the specialist society FMPP 01/19).

What kind of digitally-enabled applications are there in the field of mental health?

In order to give interested parties an insight into existing digital-based care approaches that are still being tested, digital applications within mental health care and care (e-Mental Health) are briefly described below. The treatment of mental illnesses and disorders via the Internet is currently still in the research stage. In addition, some future projects in Switzerland are presented which experts believe have the potential to improve the care prospects for people with mental illnesses.

Especially in the field of mental health and health prevention, the range of (guided) self-help approaches has multiplied in recent years (lifestyle apps, online programs, etc.). For some, studies have shown the effectiveness in many areas of disorder, while there is no information on the effectiveness of many available programs and apps, nor on possible risks and side effects.

For people who are interested in such applications without medical supervision or who are already using them, it is fundamentally very important to deal with the offers (beforehand) and to find out about their approaches, opportunities and their limits. Users should deal with the differences in content, the intended purpose and the proven effectiveness as well as data protection and security in advance of use. In the case of non-certified offers, there is always the possibility that negative aspects can arise - users should be able to find out about these in advance. Lifestyle apps, for example, are insufficient at the moment when the first symptoms of illness appear or when the disease occurs. Digital self-help offers should always provide further help for those affected in the event of worsening symptoms or an acute crisis.

Self-help apps

A wide variety of so-called prevention apps (lifestyle apps) are available on the market, which are designed to help people preventively promote their mental health as stress management training, mindfulness training or as an activity diary. These approaches are fundamentally desirable and also have the potential to improve psychological well-being. It is currently problematic, however, that there is still no proof of effectiveness for these offers and that no reliable quality criteria are currently established that allow the necessary verification of effectiveness and safety. For patients, this means that they are not yet guaranteed any verifiable use of such apps that are offered in the stores. The extent of possible side effects has also not been definitively clarified.

Online-supported interventions or internet therapy programs

So-called “Internet interventions” (also online interventions or Internet psychotherapy programs) are being developed to help people cope with psychological symptoms via the Internet. In addition to a short-term and long-term positive effect on psychological stress, self-help-oriented programs also focus on empowerment (self-efficacy) of people. Online-based interventions with psychotherapeutic approaches usually contain elements of cognitive behavioral therapy.

The number of offers has increased significantly in recent years. The new methods range from online-based preventive offers above interactive psychoeducation to special ones online treatment programs. These interventions can therapeutically accompanied or unaccompanied be, they can be complete perceived from a distance will or also in combination with personal contact with a therapist. E-mails, chat (synchronous or asynchronous) and video conferences (synchronous / audiovisual) are used for communication between patients and psychotherapists.

Online-supported interventions can be used at different times in the disease phases, for example preventive, in the use of so-called primary care (e.g. family doctors), to bridge the waiting time for a therapy place, to supplement a therapy and also after completion of a treatment for the so-called Relapse prevention.
With the modern media there are also structures to reach people in underserved regions as well as undersupplied patient groups, i.e. people who need special therapy offers that are not available nationwide.

Modules, questionnaires and self-tests
These online psychotherapy programs often consist of several modules that participants should work on about once or twice a week. Questionnaires and self-tests provide information on personal progress and at the same time allow a reaction to unfavorable developments as well as assistance in possible crises. The feedback can be automated and standardized, but also in the form of individualized feedback from psychological advisors. Sometimes a personal contact is only made by consultants when necessary (contact on demand). Education on how to deal with stress, motivation to exercise or certain health-promoting behaviors are often individual components of these complex internet-based interventions.

For example, the effectiveness of individual programs has already been proven for mild to moderate depression. Computer-assisted behavioral therapy can reduce symptoms in patients with mild disease, improve quality of life and optimize therapy. Online-based interventions can also be used as part of relapse prevention. In the case of severe degrees of illness, close medical monitoring and often the use of medication is necessary. Internet-based interventions clearly reach their limits here, but they can provide additional support.

Virtual Reality Interventions

Virtual Reality (VR) is an artificial reality that is generated by special hardware and software. With the help of VR glasses, realistic representations are created and can be supplemented by acoustic and tactile stimuli. Using various devices, it is possible to communicate with the artificially generated environment and to interact using gestures, facial expressions, posture and language.

This technology opens up treatment options that are difficult or complicated to implement in reality. The interaction with the virtual environment makes it possible to depict real experience and thus, among other things, to generate real fears (stimulus confrontation) or real desire for something. In the area of ​​fear research, it has been shown that experiencing an environment using VR can generate the same physical reactions as a real situation.

On the one hand, virtual reality can be used to expand the possibilities of researching disorders. In the context of exposure therapy, however, it can also expand the possibilities of cognitive behavioral therapy (CBT). In such a situation, patients can learn, under therapeutic supervision, to deal with their own feelings and psychological symptoms and to be able to control them effectively.
As part of “blended psychotherapy”, conventional psychotherapy can also be combined with the use of modern media - such as virtual reality - in order to improve the effectiveness of the treatment.

(Translational) neuromodeling

Translational medicine is understood to be interdisciplinary activities that have set themselves the task of transferring findings from basic research or preclinical research into clinical development as quickly and efficiently as possible in order to improve patient care. In addition to this classic translation, a new research approach has developed in recent years that deals with the existing physiological conditions and factors influencing psychiatric issues. This so called Translational neuromodeling tries on the basis of mathematical and algorithmic methods to improve the understanding of mental illnesses. Imaging data (neuroimaging) as well as electrophysiology and behavioral data are included in order to understand the individual disorders of the physiology and information processing of neural circuits and to be able to interpret them correctly for diagnosis and treatment. When dealing with these large data sets are so called Computational methods used, to bring measured or visualized pathophysiological processes into connection with one another and to make specific statements. This approach is also known as “computational assay” because one tries to establish standardized tests and models. Among other things, they should help to differentiate diseases from one another (differential diagnosis) or to be able to make predictive statements about what is to be expected for an individual treatment response (predictive test).

Voices on e-mental health and future projects in Switzerland:

In an overview article in the specialist information of the FMPP, experts who deal with the development and evaluation of e-mental health interventions and models have their say (psyCHiatrie - information from the specialist association FMPP 01/19). In the following, excerpts from some interviews are compiled to give a little insight into the point of view of technical experts and their projects:

Low-threshold therapy offers for addictions

Prof. Dr. Michael P. Schaub is head of the Swiss Institute for Addiction and Health Research (ISGF). According to the expert, people with mental illnesses can be reached through digital offers who would otherwise not come into therapy.

Her research relies on digital interventions. Why?

“We can use it to reach more patients. In Germany, the median treatment delay - i.e. the time it takes for a person affected to seek professional help - is almost 10 years. In order to influence this, new offers are needed. Online methods, like pharmacotherapy or psychotherapy, will therefore establish themselves as further therapeutic options. We can already see today that online treatment works better than conventional face-to-face therapies for certain diagnoses. "

Data protection is an issue of concern. How do you deal with that?

“All of our tools are CE-certified, are classified as“ medical devices ”and follow the European data protection regulation. The quality label is very important to us.

Many apps don't have that. Of the 67 intervention apps that we recently found in popular app stores, none had been tested for effectiveness, let alone CE-certified. "

VR apps for exposure therapy

The psychologist and federal Recognized psychotherapist and postdoctoral researcher at the trans-faculty research platform for molecular and cognitive neurosciences Dr. phil. Dorothee Bentz is working with other scientists to develop smartphone apps for treating anxiety disorders. According to guidelines, the use of digital techniques is recommended for mental illnesses when exposure in real life is not possible. Virtual reality can basically be used well and is also used to treat various diseases such as PTSD, eating disorders or addictions.

Is this technique suitable for all patients?

“Virtual reality can be used well. However, side effects, the "simulation of sickness" with dizziness and nausea, can occur in around 10% of patients. Here it has to be weighed whether the treatment benefit outweighs the side effects. The procedure is not suitable for people with migraines, seizure disorders and restricted three-dimensional vision. "

Where do you see the development potential for the future?

“I see the greatest development potential in the fact that these treatments are currently rarely offered outside of the research context. The user friendliness and quality of virtual reality technology have developed rapidly in recent years, while costs have fallen at the same time. Being able to experience virtual reality on a smartphone combined with inexpensive headsets offers great potential to complement traditional treatments in the form of “blended treatments” ”, reports Dr. Dorothee Bentz to the specialist magazine psyCHiatrie - information from the specialist association FMPP (01/19).

Neuromodeling for individual patient care

The psychiatrist PD Dr. med. Helene Haker Rössler is convinced that it will enrich the practice of psychiatry in the future to use mathematical models for differential diagnosis, prognosis and therapy prediction. The expert for autism spectrum disorders wants to find out more about the cognitive information processing in this disorder with the help of neuromodeling. At the research clinic of the Translational Neuromodeling Unit (TNU) of the University of Zurich (UZH) and ETH Zurich, where she was the former director, studies are also carried out on schizophrenia, depression of gambling addiction, in order to mathematically record individual properties of brain activity and about use this approach to improve patient care. The first studies with patients have been running for a few years. The long-term goal is to make diagnostic procedures much easier and to be able to offer the treatment of diseases in a more targeted manner.

What is particularly important to you in the context of digital medicine?
“It takes openness and careful guidance to approach this new topic without fear. Neuromodeling is the psychiatric research direction from which I hope for the most concrete, clinically feasible innovations in the foreseeable future. "

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It can be assumed that the importance of online therapies and other online offers as an important addition to today's therapy offer will continue to increase in the long term. For patients, this means paying attention to quality assurance, data protection and the protection of personal rights. Even with all progress, the value of relationships and the great importance of the human counterpart, on which we humans as social beings, must not be disregarded.

Swell:

  • psyCHiatrie - information from the specialist society FMPP 01/19
  • Factsheet E-Mental-Health - Facts and Figures (DGPPN)
  • Klein, Gerlinger; Internet-based interventions in the treatment of mental disorders; Neurologist (2016)