Technology makes mark in treatment of mental health issues

Some experts in the area say online care can be as effective as antidepressants

Trinity College counsellor Orla McLoughlin regularly conducts patient sessions via a Trinity-created platform called SilverCloud.

The platform not only offers online communication with a trained mental health professional, but it involves a range of therapeutic programs and exercises.

“All the activities, all the content, all the practical suggestions – the student does that in their own time,” says McLoughlin. “Then you meet them virtually online once a week to check in on how they’re doing”.

Across the TCD campus in the O’Reilly Institute, one of the SilverCloud creators, Prof Gavin Doherty, explains the “e-health platform” further.

Users, he says, set up a profile page and share information about their problems with a counsellor. Video diaries can be uploaded, achievements are “unlocked” as tasks are completed, while a journal feature “provides a reflective space and becomes a vehicle for therapeutic writing exercises”.

This idea of therapists communicating with patients through online care has been gaining a following for the past decade.

Dr Mark van Ommeren, a mental health expert who works with the World Health Organisation even notes that “initial studies” he has seen have shown that in terms of dealing with depression, “these programs can be as effective as clinicians or antidepressants”.

Van Ommeren highlights the work of Australian researchers such as Dr Frances Kay-Lambkin as evidence.

The research fellow at the National Drug and Alcohol Research Centre at the University of New South Wales has helped shape a “closed” program called Shade which uses 10 once-weekly sessions of cognitive behaviour therapy (CBT) which are preprogrammed to deal with issues surrounding depression, alcoholism and other conditions. CBT refers to a goal-oriented, time-specific approach to tackle negative thoughts or emotions.

At present, Shade is at its trial phase with Kay-Lambkin and other colleagues checking in weekly on each patient’s progress, monitoring their mood and discussing the effectiveness of the various exercises.

Echoing van Ommeren’s words, she says: “Our participants actually report the same benefits as a face-to-face delivered CBT programme that covers the same content. That includes reductions in depression, alcohol use and cannabis use.”

DeeAnna Merz Nagel, a US-based psychotherapist and co-editor of the 2009 book, The Use of Technology in Mental Health, feels there are benefits to this form of help over more traditional methods.

“There’s privacy obviously, but with email therapy for instance, clients can go back to our exchanges months or years later which can be very helpful. This can also help therapists in framing the progress of the process.”

Merz-Nagel is also enthusiastic about the use of Second Life’s virtual environment to treat children suffering from disorders such as Asperger’s syndrome. “Kids would be much more inclined to log on to a gaming platform and communicate there than to sit down and talk to a therapist,” she says.

Elsewhere, both Doherty and Van Ommeren also talk up the possibilities presented by smartphones in handling mental health problems.

“Previously,” says Doherty, “we had a Java-based application installed on phones so that people could record their mood. It was password protected and secure but when you compare it against a paper diary some counsellors were saying that in 20 years they’d never seen such compliance”.

He talks about the idea of sensors being placed into phones of volunteers undergoing counselling as a way to “track activity levels for those suffering from depression or other mental health issues” as well.

“In the case of bipolar disorder,” he says, “there might be certain things which suggest a manic episode approaching, in which case people could perhaps take action in terms of their behaviour.”

Evaluating stress

It’s not only those suffering from mental health issues that are exploring how technology can improve their state of mind though. Leading soccer clubs including AC Milan and Chelsea are said to use neurofeedback technology to evaluate the stress levels of their players.

In Dublin, similar technology is used at Rathfarnham’s Life and Balance Centre to give patients feedback on their stressors. Developed by Canadian company Thought Technology, the Neuroinfiniti Stress Response Evaluation involves measuring brainwave function, heart-rate variability, skin conductance, body temperature, breathing rate and muscle activity, with various distracting noises such as children screaming or dentist drills thrown in to measure emotional responses.

The centre’s Dr Tammy Verlaan-Ross says the results can then offer people lessons on how to control stress. “That’s what’s great about technology, there’s no guesswork; you know what level they’re functioning at and know where changes can be made,” she says.

Van Ommeren says neurofeedback results using such technology can be useful but the area has never really “broken through” with clinicians. For the minute, his concentration is on bringing ideas like SilverCloud and Shade to a global audience.

He speaks of the important role online therapy could play in places such as the Middle East, “where people have a lot of technology but aren’t likely to seek help, or indeed where women in particular are less likely to leave the house, to be treated for depression”.

As it is, he says, people from that part of the world think depression is “abnormal”. “They’re embarrassed and hide it away,” he says. “People suffer in silence.”