March, 2020. In my editorial entitled “Technotherapy” in the September, 2019 issue of the Journal, I discussed the evolving world of internet-based options for someone looking for online psychotherapy or just personal advice. The volume of Google responses is overwhelming—I recently entered “online psychotherapy” for a Google search and, in 47 seconds, I received 47,700,000 results. The range of options is enormous, from well-researched, valid programs such as online cognitive behavioral therapy (CBT) for depression, developed by credentialed academics, to exploitative unqualified offerings posted by unethical shysters. And since psychotherapy is not government-regulated, it’s all legal. What to do about this is pretty baffling, particularly since in between the legitimate, well-studied programs and those run by charlatans, there are lots of creative, potentially beneficial sources of help. However challenging, our job is to learn about authentic new internet treatment opportunities and to emphasize the value of these programs. Telemedicine is a growth industry and it should be, if done right. We have solid information about the substantial prevalence of neuropsychiatric disorders in the general population, and we know how pernicious and persistent is the problem of stigma, preventing people from seeking help. Valid internet options provide a “quiet” way for people to seek help. Even if we argue that we should be open about our own problems with anxiety, depression, substance use, and other challenges, and we should, the reality is that we have a long way to go. So, in the meantime, exploring help between you and your computer can be a beneficial first step. The internet also makes help available to so many who live in remote areas and have little access to professional help, and to those who cannot afford it.
In this issue of the Journal, Hoffman and colleagues present a study entitled “Digital Opportunities for Outcomes in Recovery Services (DOORS): A Pragmatic Hands-On Group Approach Toward Increasing Digital Health and Smartphone Competencies, Autonomy, Relatedness, and Alliance for Those With Serious Mental Illness.” This study is from the Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, where the senior author of the work, John Torous, MD, serves as director of the digital psychiatry program. In this work, they suggest that there is a “second digital divide,” referring to “the core competencies, autonomy, and skills required to effectively utilize” tools like smartphones and apps, to improve mental health. They contend that the DOORS program, presented here, “represents an evidence-based effort to formally bridge this new digital divide and deliver on the potential of digital mental health.” In addition to the article describing the study, the authors have provided 2 extensive manuals, outlining 2 versions of the program in detail. The Journal has posted these manuals online and they are being made available to all who are interested at no cost.
Also in this issue of the Journal, Alavi and colleagues report on the efficacy of a PowerPoint-based CBT program carried out via email for the treatment of generalized anxiety disorder. In this pilot study, these researchers found that the delivery of “e-CBT” modules was “a viable method for delivering CBT to individuals with generalized anxiety disorder and a simple method for overcoming language, cultural, and travel barriers to accessing mental health resources.”
John M. Oldham, MD