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<ref name="teleneurology" group=""></ref> or eHealth.<ref name="DellaMea2001" group=""></ref><ref name="ehealth" group=""></ref><ref name="Nicolas2012" group=""></ref> 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/><ref name="doherty" group=""></ref> Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts.<ref name="anthony" group=""></ref>[page needed]
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 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>"Game Directory". Games For Change.</ref> IOS<ref>"SuperBetter". Apple App Store. 12 June 2023.</ref> and Android<ref>"SuperBetter". Google Play App Store.</ref> is also meant for mental health improvement.
Virtual reality
Rizzo et al.<ref name="rizzo" group=""></ref> 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.<ref name="coyle" group=""></ref> 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, which has notably been shown to be about as effective as face-to-face therapy in a clinical trial.<ref>Merry SN, Stasiak K, Shepherd M, Frampton C, Fleming T, Lucassen MF (April 2012). "The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial". BMJ. 344: e2598. doi:10.1136/bmj.e2598. PMC 3330131. PMID 22517917.</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>Marcano-Belisario JS, Gupta AK, O'Donoghue J, Morrison C, Car J (January 2016). "Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study". BMJ Open. 6 (1): e009930. doi:10.1136/bmjopen-2015-009930. PMC 4735209. PMID 26801468.</ref><ref name="goss" group=""></ref>
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.<ref name="intel" group=""></ref>
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>Quan-Haase A (2015). Technology and Society: Social Networks, Power, and Inequality. Themes in Canadian Sociology (Second ed.). Don Mills, Ontario, Canada: Oxford University Press. pp. 222–223. ISBN 978-0-19-901471-2.</ref> (Quan-Haase, 2016, p. 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>"How Chatbots and AI are Changing the Healthcare Industry". 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>Inkster B, Sarda S, Subramanian V (November 2018). "An Empathy-Driven, Conversational Artificial Intelligence Agent (Wysa) for Digital Mental Well-Being: Real-World Data Evaluation Mixed-Methods Study". JMIR mHealth and uHealth. 6 (11): e12106. doi:10.2196/12106. PMC 6286427. PMID 30470676.</ref> published in the open access journal JMIR mHealth & Template:Proper name, 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>Thomas N, Woodyatt A (16 June 2020). "Children with ADHD can now be prescribed a video game, FDA says". CNN. Retrieved 18 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>Rathbone AL, Clarry L, Prescott J (November 2017). "Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review". Journal of Medical Internet Research. 19 (11): e399. doi:10.2196/jmir.8598. PMC 5727354. PMID 29187342.</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">McAlpine DD, McCreedy E, Alang S (June 2018). "The Meaning and Predictive Value of Self-rated Mental Health among Persons with a Mental Health Problem". Journal of Health and Social Behavior. 59 (2): 200–214. doi:10.1177/0022146518755485. PMID 29406825. S2CID 46799083.</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>Bell S, Wood C, Sarkar A (2019). "Perceptions of Chatbots in Therapy". Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems. ACM. pp. LBW1712:1–LBW1712:6. doi:10.1145/3290607.3313072. ISBN 9781450359719. S2CID 144207472. Retrieved 22 August 2019.</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>"Mobile app combined with face-to-face therapy helped people with psychosis". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2022-05-19. doi:10.3310/nihrevidence_50569. S2CID 249945572.</ref><ref>Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, et al. (August 2021). "Digitally supported CBT to reduce paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT". Efficacy and Mechanism Evaluation. 8 (11): 1–90. doi:10.3310/eme08110. PMID 34398537. S2CID 238644547.</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>Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, et al. (January 2022). "Digital interventions in mental health: evidence syntheses and economic modelling". Health Technology Assessment. National Institute for Health and Care Research (NIHR). 26 (1): 1–182. doi:10.3310/RCTI6942. PMC 8958412. PMID 35048909.</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">Gooding P, Kariotis T (June 2021). "Ethics and Law in Research on Algorithmic and Data-Driven Technology in Mental Health Care: Scoping Review". JMIR Mental Health. 8 (6): e24668. doi:10.2196/24668. PMC 8262551. PMID 34110297.</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
<references group="" responsive="0"><ref name="anthony"> Anthony K, Nagel DA, Goss S, eds. (2010). The Use of Technology in Mental Health: Applications, Ethics and Practice. Springfield, IL: Charles C. Thomas Publishers. ISBN 978-0-398-07953-6 – via Google Books. </ref>
<ref name="coyle"> Coyle D, Matthews M, Sharry J, Nisbet A, Doherty G (2005). "Personal Investigator: A Therapeutic 3D Game for Adolescent Psychotherapy". Journal of Interactive Technology & Smart Education. 2 (2): 73–88. CiteSeerX 10.1.1.101.9049. doi:10.1108/17415650580000034. S2CID 18405937. </ref>
<ref name="doherty"> Doherty G, Coyle D, Matthews M (July 2010). "Design and evaluation guidelines for mental health technologies". Interacting with Computers. 22 (4): 243–252. doi:10.1016/j.intcom.2010.02.006. S2CID 10486226.</ref>
<ref name=DellaMea2001> Della Mea V (22 June 2001). "What is e-health (2): the death of telemedicine?". Journal of Medical Internet Research. 3 (2): E22. doi:10.2196/jmir.3.2.e22. PMC 1761900. PMID 11720964. </ref>
<ref name="ehealth"> Kummervold PE, Johnsen JA, Skrøvseth SO, Wynn R (September 2012). "Using noninferiority tests to evaluate telemedicine and e-health services: systematic review". Journal of Medical Internet Research. 14 (5): e132. doi:10.2196/jmir.2169. PMC 3510769. PMID 23022989. </ref>
<ref name=Nicolas2012> Nicolas L (September 2012). "[EHealth, health networks and electronic health record: towards a culture of sharing and trust]" [EHealth, health networks and electronic health record: Towards a culture of sharing and trust]. Revue Médicale de Bruxelles (in français). 33 (4): 416–419. PMID 23091950. </ref>
<ref name=teleneurology> Wechsler LR, Tsao JW, Levine SR, Swain-Eng RJ, Adams RJ, Demaerschalk BM, et al. (American Academy of Neurology Telemedicine Work Group) (February 2013). "Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology". Neurology. 80 (7): 670–676. doi:10.1212/WNL.0b013e3182823361. PMC 3590056. PMID 23400317. </ref>
<ref name="goss"> Goss S, Ferns J (2010). "Using Cell/Mobile Phone SMS to Enhance Client Crisis and Peer Support". In Anthony K, Nagel DA, Goss S (eds.). The Use of Technology in Mental Health: Applications, Ethics and Practice. Springfield, IL: Charles C. Thomas Pub Ltd. pp. 56–67. ISBN 978-0-398-07953-6 – via Google Books. </ref>
<ref name="intel"> Morris ME (February 15, 2007). "Technologies for Heart and Mind: New Directions in Embedded Assessment". Intel Technology Journal. 11 (1). doi:10.1535/itj.1101.07. Archived from the original on 2008-08-18. </ref>
<ref name="rizzo"> Rizzo A, Pair J, Graap K, Manson B, McNerney PJ, Wiederhold B, et al. (2006). "A Virtual Reality Exposure Therapy Application for Iraq War Military Personnel with Post Traumatic Stress Disorder: From Training to Toy to Treatment" (PDF). In Roy M (ed.). NATO Advanced Research Workshop on Novel Approaches to the Diagnosis and Treatment of Posttraumatic Stress Disorder. Washington, DC: IOS Press. pp. 235–250.
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