Apps and online therapy for depression

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As a nutritionist at Yale-New Haven Hospital, Ilisa Nussbaum worked on the front lines of the pandemic in spring 2020. One of her responsibilities was to ensure patients with COVID-19 on ventilators met their nutritional needs. She quickly realized that she needed psychological support to get through this difficult time.

“I became paralyzed with fear of things that were supposed to be relatively safe, like walking along a railing at work overlooking an atrium,” she recalls. But all of the local therapists she contacted were so busy that they weren’t taking on new clients.

One evening, while scrolling through Facebook, Nussbaum saw an ad for a mental health app. It was a talk therapy chatbot that helps users monitor their mood. “A little robot asked me questions and sent me articles and videos on how to manage my feelings during the pandemic,” she says. “I found it very useful, especially when I was feeling overwhelmed and helpless.”

Research shows that the app she tried can actually be effective. When young adults ages 18 to 28 took it daily for 2 weeks, they experienced a more than 20% reduction in depression symptoms compared to a control group, according to a 2017 study JMIR Mental Health.

As the COVID-19 pandemic continues, stories like Nussbaum’s are becoming more common. An October 2021 study in the lancet found that nearly a third of US adults had symptoms of depression in 2021, compared with 27.8% of adults in the early months of the 2020 pandemic and 8.5% before the pandemic. As a result, online therapy platforms that connect users to a psychologist with the click of a button, as well as mental health apps, are in high demand.

The pros and cons

With anxiety and depression skyrocketing and a lack of personal therapists, there are many reasons people are attracted to taking their concerns to a therapist from the comfort of their own couch.

“Online platforms offer easy entry and are often more affordable than traditional therapies,” said Lynn Bufka, PhD, senior director of practice transformation and quality at the American Psychological Association.

Research also supports online therapy. A 2018 analysis of 20 studies compared the effectiveness of online and in-person cognitive behavioral therapy. This type of therapy helps patients change their negative thoughts and feelings. The study concluded that online cognitive therapy was as effective as the in-person version in treating anxiety and depression.

Online therapy can be even more valuable during the COVID-19 pandemic because you don’t have to take precautions like wearing a mask during sessions, says Judson Brewer, MD, PhD, director of research and innovation at the Mindfulness Center at die Brown University School of Public Health in Providence, RI.

“They can see each other face to face, which is very important for therapists because 70-80% of all communication is non-verbal,” he says. “I can see a patient’s facial expressions, which helps me better gauge their feelings.”

The bigger concern with online therapy is whether it can provide enough support for people suffering from moderate to severe depression, Bufka says. “When someone is going through a mental health crisis, my concern is that an online therapist will not be able to step in and get them to local resources that can provide emergency assistance,” she says.

Experts tend to be lukewarm about online text therapy, where you message your therapist in a secure chat window on your phone and they respond. “Emojis are very poor substitutes for body language and facial expressions,” says Brewer, who notes that there’s very little research on this type of communication. This format can be good for someone with very mild depression or a transient bout of stress or anxiety to test the waters, says Ashley Zucker, MD, director of psychiatry, Kaiser Permanente in San Bernardino County, Southern California.

Nussbaum feels the same about the automated app she used. While she feels it’s enough to get us through the stress of the pandemic right now, she warns it’s not for everyone.

“I see the…app as a stopgap measure for someone with depression and anxiety until they can get into therapy, or as an adjunct for someone who is currently in therapy,” she says. “Ultimately, if you have something specific that excites you, you want to talk to a person, not a robot.”

Find the right app for you

If you’re considering online therapy or a mental health app, Bufka says, ask the following questions:

Is the therapist licensed in your state? “This does a lot: it shows that the provider has met the minimum level of training, has a good reputation, and gives you the protection to file a complaint if things aren’t going well,” explains Bufka.

Is the platform HIPPA compliant? All licensed therapists must abide by patient confidentiality rules, whether therapy is in-person or online, Bufka says. Their website should state under the privacy statement that they use encrypted web-based platforms that are compliant with the Health Insurance Portability and Accountability Act. Some websites also have a shred button next to each text message that you can use to clear your message history.

Is there research behind it? This is especially important for mental health apps because “anyone can post one on the app store,” says Brewer. Check the app’s website to see if it’s backed by published research or if it was developed by someone at a major university.

Ultimately, online therapy and apps can be part of your overall self-care. “One of the best things about the app I used was that it required my full attention — I couldn’t look at it while I was making dinner or sitting on my exercise bike,” says Nussbaum. “Just sitting down to focus on that helped my mind stop racing. It encouraged me to relax, take deep breaths, and cultivate mindfulness—all of which are so important.”



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