Around 20% of adults experience a mental health illness every year.1 This should be a shocking figure, but it’s probably not all that surprising for most of us. Discussions surrounding mental health have long escaped the walls of therapist offices and entered the realm of small talk. Thanks to destigmatization, it’s no longer a hushed secret that many of us are struggling. The problem now is how to fix it.
Unfortunately, this increasing demand for support is something that the available mental health workforce has simply not been able to keep up with—and, of course, the price tag on therapy sessions further highlights the need for access to affordable care.2
With this problem in mind, technology has emerged as a popular solution for bridging the gap in supply and demand, with the potential to deliver care to a greater number of people at lower prices or even no cost at all. Mental health apps are asking us to check in with our mood, public figures are openly discussing their personal experiences with anxiety online, and websites are offering free crisis services that remind us to prioritize our mental health at the end of a stressful work week. But with all of these developments comes the question: is technology truly the saving grace we all hoped it would be?
In this article, we’ll discuss the limits of traditional therapy and how digital solutions may help enhance their effectiveness through tracking, personalization, and empowerment.
What comes after access? Questions to keep asking ourselves
When someone is connected with mental health support, we often consider the issue 'resolved' and leave it to rest. However, the moment someone seeks care is precisely when we should start questioning the validity of these treatments. Luckily, turning to online solutions can help us start to answer the following three questions.
1. How effective are mental health interventions?
This is where we already enter a gray zone. Though backed by plenty of research, the effectiveness of even ‘classic’ therapy methods is under debate for reasons including publishing biases,3,4 flaws in experimental design,5 and at times, only relatively modest benefits.6 Regardless of the statistical outcomes, these discussions are at least an important reminder that, although therapy is a life-saving intervention for many, it might not be a magic solution for everyone.
Of course, the criticisms of therapy would also apply to digital therapeutic methods—yet online counseling comes with additional recognized benefits such as anonymity and access. This means that for those seeking therapy with treatment barriers, such as living in a remote location or in a community where mental health issues are stigmatized, digital options can be a huge relief.
However, these advantages of digitally facilitated therapy may come at the cost of a weaker therapeutic relationship between the provider and the patient due to the missing elements of face-to-face social interactions.7 This potential risk may be problematic, given the fact that the therapeutic alliance is shown to be a consistent determinant of therapeutic outcomes.8 Research demonstrating equal effectiveness of online vs. in-person counseling exists, but researchers caution experimental flaws such as high participant dropout rates skewing the results by only including accounts of those who were motivated to stay in the trials.9 Yet, an online survey by Healthline on digital therapy shows that patients generally have a favorable view of the platforms, therapists, and overall experience, indicating that digitally facilitated therapy has a beneficial impact for most users.10
In fact, free crisis services such as text lines show the most promising effects, with around 90% of texters anonymously reporting that the service helped them—highlighting the importance of digitally accessible life-saving support.11 Although research on the long-term effects of these interventions is still missing,12 these anonymized digital interventions come with a big opportunity for measuring impact. For example, Kids Help Phone routinely gathers feedback on the impact of crisis texting or counseling sessions, a practice not typically seen in traditional therapy. As a result, we may have more evidence of the effectiveness of a single session from these mental health services than we do from multiple in-person therapy sessions.
Therefore, digital therapeutic interventions show overall promise, especially for single-session crisis response. The resulting opportunity for digital interventions is to enable reporting and tracking of these sessions, leveraging deeper insights on what leads to the best outcomes.
Digital Opportunity 1: Impact Tracking
A lack of impact monitoring efforts is a major point of criticism for traditional therapy.15 Technology has the potential to facilitate the tracking of mental health interventions in an easy and engaging manner.
For the industry, this offers an opportunity to gain deeper insights into which interventions are most effective for specific profiles, while users can better understand which interventions are working for them—or if they are no longer beneficial. This way, they can make better informed changes.
2. Is therapy right for me?
The critical movement toward awareness and acceptance of mental health topics seems to have led to advocates and marketing messages proclaiming that ‘therapy is for everyone.’ And of course, everyone should have access to therapy, but we must ask ourselves: is therapy beneficial for everyone?
To address this question let’s talk about Iatrogenic effects. This unsexy term describes the possible negative effects of a medical intervention intended to treat another problem.14 Basically, this is the reason why a doctor would never recommend surgery to someone who has minor knee pain: the benefits of the surgery simply wouldn’t outweigh the risks of introducing another issue. What may be less known, or at least talked about, is that these risks also exist for mental health interventions.15 For therapy, these can include using the wrong approach, applying a technique incorrectly, as well as not knowing how to develop a therapeutic alliance.
In order to address such risks, digital methods could be used to personalize the offering to the patient. For one, this could include an onboarding session that helps a person understand which type of therapy is best for them, or if a different treatment would be more effective altogether. Providing helpful information on options and suitable alternatives could save individuals time, money, and the stress of feeling like an intervention isn’t working—when it might just not be the right one for them.
For those who feel confident that therapy is what they need to address their struggles, digital tools could further be utilized to personalize the sessions and possibly even build stronger therapeutic relationships. One important reason why therapy can be unhelpful is by, for example, failing to check in with the client whether an approach works for them.16 Digital solutions easily allow for personalization via goal setting and relevant suggestions, which could help the receiver of care feel more heard, and hold the care-giver more accountable to session outcomes. To take it one step further, digital tools could even be used to match a therapist with the care-receiver, a technique that has shown promising results in a UK-based study involving over 4800 participants.17
Digital Opportunity 2: Personalization
To address pain points in traditional therapy such as finding the right therapist ‘match’ or addressing a lack of goal setting, personalization features can be used to improve the overall experience and create clearer session outcomes.
3. What else can I do for my mental health?
Of course, therapy may be one of the best solutions for moderate to severe mental health struggles. But that doesn’t mean we should just kick-back and wait so see if it works for us. Rather, there are other techniques that have proven to have a positive effect on our overall well-being that could be used in conjunction with traditional mental health interventions.
Activities like meditation,18 checking in with our mental state,19 and regularly exercising20 are just some of the tools that you may recognize from the plethora of well-being apps you keep hearing about—and for good reason. The above-mentioned activities have research backing their effectiveness for reducing feelings of anxiety, stress, and depression, and are a great way for individuals to feel empowered to take their mental health into their own hands.
What makes these methods truly worth trying is the low risk of implementation—in addition to being highly accessible through digital interventions. Well-being apps exist to support us in the adoption and retention of such good habits. They have the possibility to remind us of our good intentions, whether through simple reminders or by, for example, sharing your progress with people in your network. Overall, empowering the user to take on small challenges can be a great addition to more traditional mental health interventions.
Digital Opportunity 3: Self-Empowerment
Even when we are struggling, a supportive app that encourages us to adopt habits and try new proven ways to address our mental health can help us in conjunction with traditional interventions. These apps empower users to take charge of their lives in simple ways to help boost their mood and overall well-being.
What comes next?
Overall, we discussed how Tracking, Personalization, and Empowerment through digital solutions can help enhance the effect traditional mental health interventions can have. However, just like with any complex problems, more research is required to fully understand the impact of, not just traditional mental health interventions, but those administered through digital tools.
It goes without saying that for a digital solution to be helpful, users also have to want to interact with it repeatedly. This is where we enter the world of human-centered design for driving engagement. Conveniently, human-centered design is also something we do at TDL for a wide variety of fields, including (but not limited to) the mental health space. If you are new to this topic, here are some resources to get you started! And if you are ready to start the journey of leveraging the benefits of digital solutions to enhance your impact, we would be delighted to guide you through the process.
