September, 2019. OK, I invented the term “technotherapy,” but it’s all around us. Websites abound offering relatively inexpensive online therapy, via chat, phone, video, text, email. One clearly google-optimized site offers access to 4000 therapists, to deal with depression, stress, anxiety, self-esteem, anger, relationships, grief, and more, for an average weekly cost of $65. The therapists are licensed and the site is HIPAA-compliant. Though I don’t know anyone who has tried it, this site seems “legit” even if its claims feel a bit over the top. But then there are other sites that clearly are not legit—such as one that links you to “car therapy” and “apartment therapy.” For decades, the online world of therapists, counselors, healers, self-anointed experts, and wizards of cure has been what we used to call cowboy territory or the wild west.
But technology is indeed changing rapidly, and we need to monitor the use of technology in our field for quality and reliability. A piece in the July 4, 2019 New York Times was entitled “Instagram therapists offer advice, no couch needed,” with this subheading: “Should free mental health suggestions be doled out like a poem or a recipe?” The author describes the Instagram accounts of 2 licensed marriage and family therapists, both of whom have active office practices, who offer free advice and counseling online. They specify that this is no substitute for therapy, but it may be helpful as a way to augment therapeutic work.
Telemedicine itself is a growth industry. I’m on the North American Medical Advisory Board of Teladoc Health, which provides telemedicine services across all medical specialties. Behavioral health has been one of the newest specialties to join these ranks, and this is an important development as it can provide access to mental health care for those who live in remote areas and it can provide a channel for help that can minimize the discomfort that many people feel about seeing a mental health provider.
What lies ahead? I don’t think we can even imagine it. But here’s an example: In the June 18 New York Times Science Times, an article appeared entitled “Mental Distress Gauged by App.” Among other things, the piece focused on a relatively new company called “Mindstrong,” founded by Tom Insel MD, the former Director of the National Institute of Mental Health, which is developing something called a “digital fire alarm.” Using an embedded alternate keyboard as an app installed on iPhones, moment-to-moment screen time can be monitored. This device is being studied with volunteers who have borderline personality disorder. By establishing a “digital phenotype” (baseline keyboard use for each volunteer), the program can then alert the user when emotions may be going off the rails. Whether this would truly serve as an early alarm that could help stabilize or divert what might otherwise become an episode of emotion dysregulation is yet to be evaluated.
In this issue of the Journal, Moukaddam and colleagues present pilot data on a new app called Smartphone and OnLine usage-based eValuation for Depression (SOLVD), developed to monitor intensity of depression and compare the app-measured depression trajectory with values from sequential use of standardized instruments such as the PHQ-9, the HAM-D, and the HAM-A. These researchers found a strong correlation between daily self-reported moods, using the app, and the standardized measures they examined. The authors speculate that this strategy might be a helpful adjunct to treatment in a number of ways, such as early identification of deepening depression in order to implement just-in-time treatment.
JOHN M. OLDHAM, MD