View source for Use of technology in treatment of mental disorders

The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as [[telemedicine]]{{r|teleneurology}} or [[eHealth]].{{r|DellaMea2001}}{{r|ehealth}}{{r|Nicolas2012}} The use of such technologies as a supplement to mainstream therapies for [[mental disorders]] is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care.<ref name=MarcanoBelisario_et_al-2016/>{{r|doherty}} Mental health technologies used by professionals as an adjunct to mainstream clinical practices include [[email]], [[SMS]], [[virtual reality]], [[computer program]]s, [[blog]]s,  [[social network]]s, the [[telephone]], [[Video conference|video conferencing]], [[computer game]]s, [[instant messaging]] and [[podcast]]s.{{r|anthony}}{{page needed|date=June 2017}}

== Specific technologies ==
Traditional methods of helping people with a mental health problem have been to use approaches such as medication, counselling, [[cognitive behavioral therapy]] (CBT), exercise and a healthy diet. New technology can also be used in conjunction with traditional methods.

=== PC devices ===
[[TED (conference)|TED]] speaker Jane McGonigal's website [[Games For Change]] includes a health category, which presents many mental health improving and education games. Additionally, her own game, Super Better for PC,<ref>{{cite web |url= http://www.gamesforchange.org/games/?q=&tr=868 |title= Game Directory|website=Games For Change}}</ref> IOS<ref>{{cite web |url = https://itunes.apple.com/us/app/superbetter/id536634968?mt=8&ign-mpt=uo=4|title=SuperBetter |website= Apple App Store |date=12 June 2023 }}</ref> and Android<ref>{{cite web |url= https://play.google.com/store/apps/details?id=com.superbetter.paid&hl=en |title=SuperBetter |website= Google Play App Store }}</ref> is also meant for mental health improvement.

=== Virtual reality ===
{{See also|Virtual reality therapy|Virtual reality#Healthcare and clinical therapies}}
Rizzo et al.{{r|rizzo}} have used [[virtual reality]] (VR) (simulated real environments through digital media) to successfully treat [[post-traumatic stress disorder]] (PTSD).  The VR system offers a sense of realism in a safe environment.  By gradually exposing the person to their fear with a Virtual Environment the patient becomes accustomed to the trigger of their problem to an extent that it no longer becomes an issue.  This form of treatment has also been applied to other [[mental health]] problems such as [[phobias]] (where anxiety is triggered by a certain situation).  For example, [[fear of flying]] or [[arachnophobia]] (fear of spiders).  Computer games have also been used to provide therapy for adolescents.{{r|coyle}} Many adolescents are reluctant to have therapy and a computer game is a fun, anonymous and accessible way to receive therapeutic advice.  An example of a computer game that provides such therapy is [[Sparx (video game)|SPARX]], which has notably been shown to be about as effective as face-to-face therapy in a clinical trial.<ref>{{cite journal | vauthors = Merry SN, Stasiak K, Shepherd M, Frampton C, Fleming T, Lucassen MF | title = The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial | journal = BMJ | volume = 344 | pages = e2598 | date = April 2012 | pmid = 22517917 | pmc = 3330131 | doi = 10.1136/bmj.e2598 }}</ref>

=== Mobile devices ===

Relatively new technology such as mobile phones have also been used to help people with mental health problems by providing timely information.<ref name=MarcanoBelisario_et_al-2016>{{cite journal | vauthors = Marcano-Belisario JS, Gupta AK, O'Donoghue J, Morrison C, Car J | title = Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study | journal = BMJ Open | volume = 6 | issue = 1 | pages = e009930 | date = January 2016 | pmid = 26801468 | pmc = 4735209 | doi = 10.1136/bmjopen-2015-009930 }}</ref>{{r|goss}}

As technology improves, it may soon be possible for mobile phones or other devices to sense when people are changing state (e.g. entering a manic or a deeply depressed phase), for instance by noticing a change in voice pattern or usage frequency, or facial tension. It may also become possible to measure physical evidence of levels of distress and suffering, such as changes in hormones or adrenalin in blood, and changes in brain activity. Apps may also be able to predict high stress situations, based on location, time, activity (e.g. purchasing of alcohol) and nearby presence of high risk people. The technology could then send calming messages to patients, automatically alert carers and even automatically administer meds.{{r|intel}}

There are different technologies that are used in the mental health field over the past 30 years. "Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device's built-in sensors to collect information on a user's typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs" (Technology and the Future of Mental Health Treatment, n.d.). This connects to Quan-Haase reading about surveillance. The use of a mobile app that knows people behavior has private information about the people who use it. The people are being watched by the app creator or company. Functional view argues that societies, in order to operate effectively, require some element of security and safety. To achieve these goals, personal information in surveillance are only for a degree, not of kind. "This form of surveillance is harmless since third-party companies are primarily interested in aggregate data and will use this information for the purpose of developing and marketing better products, which will benefit consumers in the long run".<ref>{{cite book | vauthors = Quan-Haase A |title=Technology and Society: Social Networks, Power, and Inequality | series = Themes in Canadian Sociology |date=2015 |location=Don Mills, Ontario, Canada | publisher = Oxford University Press |isbn=978-0-19-901471-2 |pages=222–223 |edition=Second}}</ref> (Quan-Haase, 2016, p.&nbsp;222-223). There are many pros of using mental health app such as it is convenience, lower cost, and 24-hour service.

Technology companies are developing mobile-based artificial intelligence [[chatbot]] applications that use evidence-based techniques, such as [[cognitive behavioral therapy]] (CBT), to provide early intervention to support [[mental health]] and [[emotional well-being]] challenges.<ref>{{Cite web |url=https://zenbit.tech/blog/how-chatbots-and-ai-are-changing-the-healthcare-industry/ |title=How Chatbots and AI are Changing the Healthcare Industry|date=11 July 2022 }}</ref> [[Artificial intelligence]] (AI) text-based conversational applications delivered securely and privately over mobile devices have the ability to scale globally and offer contextual and always-available support. A recent [[real world data]] evaluation study,<ref>{{cite journal | vauthors = Inkster B, Sarda S, Subramanian V | title = An Empathy-Driven, Conversational Artificial Intelligence Agent (Wysa) for Digital Mental Well-Being: Real-World Data Evaluation Mixed-Methods Study | journal = JMIR mHealth and uHealth | volume = 6 | issue = 11 | pages = e12106 | date = November 2018 | pmid = 30470676 | pmc = 6286427 | doi = 10.2196/12106 | doi-access = free }}</ref> published in the open access journal JMIR mHealth & {{Proper name|uHealth}}, that used an AI-based emotionally intelligent mobile chatbot app, Wysa, identified a significantly higher average improvement in symptoms of depression and a higher proportion of positive in-app experience among the more engaged users of the app as compared to the less engaged users.

On 15 June 2020, the [[Food and Drug Administration]] approved the first video game treatment, a game for children aged 8–12 with certain types of [[ADHD]] called ''EndeavorRx''. It can be downloaded with a prescription onto a mobile device, and is intended for use in tandem with other treatments. Patients play it for 30 minutes a day, 5 days a week, over a month-long treatment plan.<ref>{{cite news | vauthors = Thomas N, Woodyatt A |title=Children with ADHD can now be prescribed a video game, FDA says |url=https://www.cnn.com/2020/06/16/health/adhd-fda-game-intl-scli-wellness/index.html |access-date=18 June 2020 |work=CNN |date=16 June 2020}}</ref>

=== Technology and cognitive behavioral therapy ===

The development of mobile phone apps using cognitive behavioral therapy (CBT) has an increasing research area.<ref>{{cite journal | vauthors = Rathbone AL, Clarry L, Prescott J | title = Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review | journal = Journal of Medical Internet Research | volume = 19 | issue = 11 | pages = e399 | date = November 2017 | pmid = 29187342 | pmc = 5727354 | doi = 10.2196/jmir.8598 | doi-access = free }}</ref> Using the idea of cognitive behavioral therapy (CBT) apps, self-rated mental health (SRMH) situations can be implemented into these apps and used as information before seeing a professional. Recent research done with self-rated mental health (SRMH) involves survey research which is conducted by with a question that asks respondents to rate their overall mental or emotional health from poor to excellent.<ref name=":0">{{cite journal | vauthors = McAlpine DD, McCreedy E, Alang S | title = The Meaning and Predictive Value of Self-rated Mental Health among Persons with a Mental Health Problem | journal = Journal of Health and Social Behavior | volume = 59 | issue = 2 | pages = 200–214 | date = June 2018 | pmid = 29406825 | doi = 10.1177/0022146518755485 | s2cid = 46799083 | author-link3 = Sirry Alang }}</ref> The research found with SRMH showed that 62% of people with a mental health problem rated themselves as having positive mental health. The respondents who rated their mental health as good when compared to those with poor mental health, had 30% lower odds of having a mental health problem at a follow-up. This research showcased that without treatment, people with a mental health problem did better if they perceived their mental health in a positive way by declaring a good overall mental or emotional health.<ref name=":0" />

While studies have investigated the clinical efficacy of remote-, internet- and chatbot-based therapy, there are other factors, such as enjoyment and smoothness, that are important for evaluating therapy sessions. Research published in 2019 reported a comparative study of therapy sessions following the interaction of 10 participants with human therapists versus a chatbot (simulated using a Wizard of Oz protocol), finding evidence to suggest that when compared against a human therapist control, participants find chatbot-provided therapy less useful, less enjoyable, and their conversations less smooth (a key dimension of a positively-regarded therapy session).<ref>{{cite book |vauthors = Bell S, Wood C, Sarkar A |title=Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems |chapter=Perceptions of Chatbots in Therapy |date=2019 |pages=LBW1712:1–LBW1712:6 |doi=10.1145/3290607.3313072 |chapter-url=https://dl.acm.org/citation.cfm?doid=3290607.3313072 |access-date=22 August 2019 |publisher=ACM|isbn=9781450359719 |s2cid=144207472 }}</ref>

A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an app that helps people notice their "unhelpful fast-thinking" might be more effective for treating [[paranoia]] in people with [[psychosis]] than CBT alone.<ref>{{Cite journal |date=2022-05-19 |title=Mobile app combined with face-to-face therapy helped people with psychosis |url=https://evidence.nihr.ac.uk/alert/slowmo-app-reduced-paranoia-in-people-with-psychosis/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_50569|s2cid=249945572 }}</ref><ref>{{cite journal | vauthors = Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Hardy A | display-authors = 6 | title = Digitally supported CBT to reduce paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT | journal = Efficacy and Mechanism Evaluation | volume = 8 | issue = 11 | pages = 1–90 | date = August 2021 | pmid = 34398537 | doi = 10.3310/eme08110 | s2cid = 238644547 | doi-access = free }}</ref>

== Effects and impact ==

=== Economic evaluations ===
From an economical perspective, digital interventions for mental health conditions seem to be cost-effective compared to no intervention or non-therapeutic responses such as monitoring. However, when compared to in-person therapy or medication their added value is currently uncertain.<ref>{{cite journal | vauthors = Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L | display-authors = 6 | title = Digital interventions in mental health: evidence syntheses and economic modelling | journal = Health Technology Assessment | volume = 26 | issue = 1 | pages = 1–182 | date = January 2022 | pmid = 35048909 | pmc = 8958412 | doi = 10.3310/RCTI6942 | publisher = National Institute for Health and Care Research (NIHR) }}</ref>

== Ethical, legal and social issues ==
There is uncertainty around the ethical and legal implications of digital technologies in the mental health context, including the use of artificial intelligence, machine learning, deep learning, and other forms of automation. Ethical and legal issues tend to not be explicitly addressed in empirical studies on algorithmic and data-driven technologies in mental health initiatives.<ref name=":1">{{cite journal | vauthors = Gooding P, Kariotis T | title = Ethics and Law in Research on Algorithmic and Data-Driven Technology in Mental Health Care: Scoping Review | journal = JMIR Mental Health | volume = 8 | issue = 6 | pages = e24668 | date = June 2021 | pmid = 34110297 | pmc = 8262551 | doi = 10.2196/24668 | doi-access = free }}</ref> Concerns have been raised about the near-complete lack of involvement of mental health service users, the scant consideration of [[algorithmic accountability]], and the potential for overmedicalization and techno-solutionism.<ref name=":1" />

== References ==
{{Reflist|30em|refs=

<ref name="anthony">
{{cite book| veditors = Anthony K, Nagel DA, Goss S |title=The Use of Technology in Mental Health: Applications, Ethics and Practice |year=2010 |publisher=Charles C. Thomas Publishers |location=Springfield, IL |isbn=978-0-398-07953-6 |url={{google books|sX87shVB0ugC|plainurl=yes}} |via=Google Books }}
</ref>

<ref name="coyle">
{{cite journal | vauthors = Coyle D, Matthews M, Sharry J, Nisbet A, Doherty G |year=2005 |title=Personal Investigator: A Therapeutic 3D Game for Adolescent Psychotherapy |journal=Journal of Interactive Technology & Smart Education |volume=2 |issue=2 |pages=73–88 |citeseerx=10.1.1.101.9049 |doi=10.1108/17415650580000034|s2cid=18405937 }}
</ref>

<ref name="doherty">
{{cite journal | vauthors = Doherty G, Coyle D, Matthews M |title=Design and evaluation guidelines for mental health technologies |journal=Interacting with Computers |date=July 2010 |volume=22 |issue=4 |pages=243–252 |doi=10.1016/j.intcom.2010.02.006 |s2cid=10486226 }}</ref>

<ref name=DellaMea2001>
{{cite journal | vauthors = Della Mea V | title = What is e-health (2): the death of telemedicine? | journal = Journal of Medical Internet Research | volume = 3 | issue = 2 | pages = E22 | date = 22 June 2001 | pmid = 11720964 | pmc = 1761900 | doi = 10.2196/jmir.3.2.e22 | doi-access = free }}
</ref>

<ref name="ehealth">
{{cite journal | vauthors = Kummervold PE, Johnsen JA, Skrøvseth SO, Wynn R | title = Using noninferiority tests to evaluate telemedicine and e-health services: systematic review | journal = Journal of Medical Internet Research | volume = 14 | issue = 5 | pages = e132 | date = September 2012 | pmid = 23022989 | pmc = 3510769 | doi = 10.2196/jmir.2169 | doi-access = free }}
</ref>

<ref name=Nicolas2012>
{{cite journal | vauthors = Nicolas L | title = [EHealth, health networks and electronic health record: towards a culture of sharing and trust] | language = fr | journal = Revue Médicale de Bruxelles | volume = 33 | issue = 4 | pages = 416–419 | date = September 2012 | pmid = 23091950 | trans-title = EHealth, health networks and electronic health record: Towards a culture of sharing and trust }}
</ref>

<ref name=teleneurology>
{{cite journal | vauthors = Wechsler LR, Tsao JW, Levine SR, Swain-Eng RJ, Adams RJ, Demaerschalk BM, Hess DC, Moro E, Schwamm LH, Steffensen S, Stern BJ, Zuckerman SJ, Bhattacharya P, Davis LE, Yurkiewicz IR, Alphonso AL | display-authors = 6 | title = Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology | journal = Neurology | volume = 80 | issue = 7 | pages = 670–676 | date = February 2013 | pmid = 23400317 | pmc = 3590056 | doi = 10.1212/WNL.0b013e3182823361 | collaboration = American Academy of Neurology Telemedicine Work Group }}
</ref>

<ref name="goss">
{{cite book| vauthors = Goss S, Ferns J |year=2010|chapter=Using Cell/Mobile Phone SMS to Enhance Client Crisis and Peer Support| veditors = Anthony K, Nagel DA, Goss S |title=The Use of Technology in Mental Health: Applications, Ethics and Practice|publisher=Charles C. Thomas Pub Ltd|location=Springfield, IL|pages=56–67|chapter-url={{google books|sX87shVB0ugC|page=56|plainurl=yes}} |via=Google Books |isbn=978-0-398-07953-6}}
</ref>

<ref name="intel">
{{cite journal|url=http://www.intel.com/technology/itj/2007/v11i1/7-heart-mind/5-case-study-three.htm|title=Technologies for Heart and Mind: New Directions in Embedded Assessment|date= February 15, 2007|journal=Intel Technology Journal|volume=11|issue=1|doi=10.1535/itj.1101.07| vauthors = Morris ME |archive-url=https://web.archive.org/web/20080818161834/http://www.intel.com/technology/itj/2007/v11i1/7-heart-mind/5-case-study-three.htm|archive-date=2008-08-18}}
</ref>

<ref name="rizzo">
{{cite book| vauthors = Rizzo A, Pair J, Graap K, Manson B, McNerney PJ, Wiederhold B, Wiederhold M, Spira J | display-authors = 6 |year=2006|chapter=A Virtual Reality Exposure Therapy Application for Iraq War Military Personnel with Post Traumatic Stress Disorder: From Training to Toy to Treatment| veditors = Roy M |title=NATO Advanced Research Workshop on Novel Approaches to the Diagnosis and Treatment of Posttraumatic Stress Disorder|publisher=IOS Press|location=Washington, DC|pages=235–250|chapter-url=http://www.macs.hw.ac.uk/modules/F24VS2/Resources/RizzoVirtualRealityExposure2006.pdf}}
</ref>

}}

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