Optimising Mental Health in a Virtual World – Connecting from a Distance
College of Psychiatrists of Ireland Medical Student and Intern Essay Prize 2021 Runner Up
Keywords:
Mental health, Technology, Internet-based cognitive behavioural therapy, Virtual therapy, Evidence-based psychiatryAbstract
• The use of modern technology and virtual approaches to mental health therapy is growing in importance across a diverse range of disorders.
• While existing mental health therapies have been successfully adapted to virtual modes of delivery, modern technology is also driving exciting novel therapies.
• Studies suggest virtual approaches to mental health care have both advantages and disadvantages. Further study and a cautious, evidence-based approach is key.
• The complex and co-morbid nature of psychiatry means that patients will continue to require assessment and management by specialists. Virtual therapies are useful components of a stepped-care model, however patients with severe mental health problems will continue to require in-person care.
References
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8. Stasiak K, Fleming T, Lucassen MF, Shepherd MJ, Whittaker R, Merry SN. Computer-Based and Online Therapy for Depression and Anxiety in Children and Adolescents. J Child Adolesc Psychopharmacol. 2016 Apr;26(3):235-45. doi: 10.1089/cap.2015.0029. Epub 2015 Oct 14. PMID: 26465266.
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15. Ljótsson B, Atterlöf E, Lagerlöf M, Andersson E, Jernelöv S, Hedman E, Kemani M, Wicksell RK. Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn Behav Ther. 2014;43(2):93-104. doi: 10.1080/16506073.2013.846401. Epub 2013 Nov 12. PMID: 24215278.
16. Simister HD, Tkachuk GA, Shay BL, Vincent N, Pear JJ, Skrabek RQ. Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia. J Pain. 2018 Jul;19(7):741-753. doi: 10.1016/j. jpain.2018.02.004. Epub 2018 Mar 2. PMID: 29481976.
17. Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R. Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Curr Psychiatry Rep. 2017 Jul;19(7):42. doi: 10.1007/ s11920-017-0788-4. PMID: 28540594.
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19. Anguera, J., Boccanfuso, J., Rintoul, J. et al. Video game training enhances cognitive control in older adults. Nature 501, 97–101 (2013). https://doi.org/10.1038/nature12486.
20. Food and Drug Administration. FDA Permits Marketing of First Game- Based Digital Therapeutic to Improve Attention Function in Children with ADHD. FDA.gov; [cited 23/04/2021] Available from: https://www.fda.gov/ news events/press-announcements/fda-permits-marketing-first-gamebased- digital-therapeutic-improve-attention-function-children-adhd
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22. Mishra, J., Sagar, R., Parveen, S. et al. Closed-loop digital meditation for neurocognitive and behavioral development in adolescents with childhood neglect. Transl Psychiatry 10, 153 (2020). https://doi. org/10.1038/s41398-020-0820-z
23. Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, Holtmann M, Santosh P, Stevenson J, Stringaris A, Zuddas A, Sonuga- Barke EJ, & European ADHD Guidelines Group (EAGG). Cognitive training for attention deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 2015, 54(3), 164–174. doi:10.1016/j.jaac.2014.12.010
24. Mishra J, Anguera J, Gazzaley A, Video Games for Neuro-Cognitive Optimization. Neuron. 2016, Volume 90, Issue 2. doi:10.1016/j. neuron.2016.04.010.
25. Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 2019, 18: 20-28. doi:10.1002/wps.20610.
26. Rozental A, Magnusson K, Boettcher J, Andersson G, Carlbring P. For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy. J Consult Clin Psychol. 2017 Feb;85(2):160-177. doi: 10.1037/ccp0000158. Epub 2016 Oct 24. PMID: 27775414.
27. Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J,
Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med. 2018 Nov;48(15):2456-2466. doi: 10.1017/ S0033291718000648. Epub 2018 Mar 15. PMID: 29540243; PMCID: PMC6190066.
28. Rozental A, Castonguay L, Dimidjian S, Lambert M, Shafran R, Andersson G, Carlbring P. Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open. 2018 Jul 25;4(4):307-312. doi: 10.1192/bjo.2018.42. PMID: 30083384; PMCID: PMC6066991.
29. van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One. 2014 Jul 16;9(7):e100674. doi: 10.1371/journal.pone.0100674. PMID: 25029507; PMCID: PMC4100736.
30. Mohr DC, Siddique J, Ho J, Duffecy J, Jin L, & Fokuo JK. Interest in behavioral and psychological treatments delivered face-to-face, by telephone, and by internet. Ann Behav Med. 2010, 40(1), 89–98. doi:10.1007/s12160-010-9203-7.
31. Hyland P, Vallières F, Cloitre M, Ben-Ezra M, Karatzias T, Olff M, Murphy J, Shevlin M. Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2020 Jul 6. doi: 10.1007/s00127-020-01912-x. Epub ahead of print. PMID: 32632598.
32. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 2005, 62(6), 617–627. doi:10.1001/archpsyc.62.6.617.
33. Nordgreen T, Haug T, Öst LG, Andersson G, Carlbring P, Kvale G, Tangen T, Heiervang E, Havik OE. Stepped Care Versus Direct Faceto-
Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial. Behav Ther. 2016 Mar;47(2):166-83. doi: 10.1016/j.beth.2015.10.004. Epub 2015 Oct 28. PMID: 26956650.
34. Jolstedt M, Vigerland S, Mataix-Cols D, et al. Long-term outcomes of internet-delivered cognitive behaviour therapy for paediatric anxiety disorders: towards a stepped care model of health care delivery. Eur Child Adolesc Psychiatry, 2020. doi:10.1007/s00787-020-01645-x.
35. College of Psychiatrists of Ireland. Digital Technology in Mental Health Services: Dr. John Hillery & Dr. Bobby Smyth. College of Psychiatrists of Ireland; [cited 23/04/2021]. Available from: https://www.irishpsychiatry. ie/blog/digital-technology-in-mental-health-services-dr-john-hillery-drbobby- smyth/
s11126-017-9535-6. PMID: 29090428.
2. Viner RM, Gireesh A, Stiglic N, Hudson LD, Goddings AL, Ward JL, Nicholls DE. Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among
young people in England: a secondary analysis of longitudinal data. Lancet Child Adolesc Health. 2019 Oct;3(10):685-696. doi: 10.1016/S2352- 4642(19)30186-5. Epub 2019 Aug 13. Erratum in: Lancet Child Adolesc Health. 2020 Jan;4(1):e4. PMID: 31420213.
3. Naslund JA, Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016 Apr;25(2):113-22. doi: 10.1017/S2045796015001067. Epub 2016 Jan 8. PMID: 26744309; PMCID: PMC4830464.
4. Webb CA, Rosso IM, Rauch SL. Internet-Based Cognitive-Behavioral Therapy for Depression: Current Progress and Future Directions. Harvard Review of Psychiatry, 2017, 25(3), 114–122. doi:10.1097/ HRP.0000000000000139.
5. Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. 2013 Apr 26;3(4):e002542. doi: 10.1136/ bmjopen-2012-002542. PMID: 23624992; PMCID: PMC3641456.
6. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004 Nov;82(11):858-66. Epub 2004 Dec 14. PMID: 15640922; PMCID: PMC2623050.
7. Andersson G, Bergström J, Holländare F, Carlbring P, Kaldo V, Ekselius L. Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry. 2005 Nov;187:456-61. doi: 10.1192/bjp.187.5.456. PMID: 16260822.
8. Stasiak K, Fleming T, Lucassen MF, Shepherd MJ, Whittaker R, Merry SN. Computer-Based and Online Therapy for Depression and Anxiety in Children and Adolescents. J Child Adolesc Psychopharmacol. 2016 Apr;26(3):235-45. doi: 10.1089/cap.2015.0029. Epub 2015 Oct 14. PMID: 26465266.
9. Ebert DD, Zarski AC, Christensen H, Stikkelbroek Y, Cuijpers P, Berking M, Riper H. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS One. 2015 Mar 18;10(3):e0119895. doi: 10.1371/journal.pone.0119895. PMID: 25786025; PMCID: PMC4364968.
10. HSE. Minding Your Wellbeing Programme: HSE; [published 3 November 2020; cited 23/04/2021]. Available from: https://www2.hse.ie/healthyyou/ minding-your-wellbeing-programme.html
11. NHS. Mental Health Apps: NHS; [cited 23/04/2021]. Available from: https://www.nhs.uk/apps-library/category/mental-health/
12. Calm Harm. Calm Harm App; [cited 23/04/2021]. Available from: https:// calmharm.co.uk/
13. Healios. Think Ninja App; [cited 23/04/2021]. Available from: https:// www.healios.org.uk/services/thinkninja1
14. Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014; 13(1), 4–11. doi:10.1002/wps.20083.
15. Ljótsson B, Atterlöf E, Lagerlöf M, Andersson E, Jernelöv S, Hedman E, Kemani M, Wicksell RK. Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn Behav Ther. 2014;43(2):93-104. doi: 10.1080/16506073.2013.846401. Epub 2013 Nov 12. PMID: 24215278.
16. Simister HD, Tkachuk GA, Shay BL, Vincent N, Pear JJ, Skrabek RQ. Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia. J Pain. 2018 Jul;19(7):741-753. doi: 10.1016/j. jpain.2018.02.004. Epub 2018 Mar 2. PMID: 29481976.
17. Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R. Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Curr Psychiatry Rep. 2017 Jul;19(7):42. doi: 10.1007/ s11920-017-0788-4. PMID: 28540594.
18. Nature. Volume 501 Issue 7465, 5 September 2013; Springer Nature Limited; [cited 23/04/2021]. Available from: https://www.nature.com/ nature/volumes/501/issues/7465
19. Anguera, J., Boccanfuso, J., Rintoul, J. et al. Video game training enhances cognitive control in older adults. Nature 501, 97–101 (2013). https://doi.org/10.1038/nature12486.
20. Food and Drug Administration. FDA Permits Marketing of First Game- Based Digital Therapeutic to Improve Attention Function in Children with ADHD. FDA.gov; [cited 23/04/2021] Available from: https://www.fda.gov/ news events/press-announcements/fda-permits-marketing-first-gamebased- digital-therapeutic-improve-attention-function-children-adhd
21. Kollins S, DeLoss D, Canadas E, Lutz J, Findling R, Keefe R, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. The Lancet Digital Health volume 2, issue 4. 1st April 2020. doi: https://doi.org/10.1016/S2589- 7500(20)30017-0.
22. Mishra, J., Sagar, R., Parveen, S. et al. Closed-loop digital meditation for neurocognitive and behavioral development in adolescents with childhood neglect. Transl Psychiatry 10, 153 (2020). https://doi. org/10.1038/s41398-020-0820-z
23. Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, Holtmann M, Santosh P, Stevenson J, Stringaris A, Zuddas A, Sonuga- Barke EJ, & European ADHD Guidelines Group (EAGG). Cognitive training for attention deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 2015, 54(3), 164–174. doi:10.1016/j.jaac.2014.12.010
24. Mishra J, Anguera J, Gazzaley A, Video Games for Neuro-Cognitive Optimization. Neuron. 2016, Volume 90, Issue 2. doi:10.1016/j. neuron.2016.04.010.
25. Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 2019, 18: 20-28. doi:10.1002/wps.20610.
26. Rozental A, Magnusson K, Boettcher J, Andersson G, Carlbring P. For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy. J Consult Clin Psychol. 2017 Feb;85(2):160-177. doi: 10.1037/ccp0000158. Epub 2016 Oct 24. PMID: 27775414.
27. Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J,
Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med. 2018 Nov;48(15):2456-2466. doi: 10.1017/ S0033291718000648. Epub 2018 Mar 15. PMID: 29540243; PMCID: PMC6190066.
28. Rozental A, Castonguay L, Dimidjian S, Lambert M, Shafran R, Andersson G, Carlbring P. Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open. 2018 Jul 25;4(4):307-312. doi: 10.1192/bjo.2018.42. PMID: 30083384; PMCID: PMC6066991.
29. van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One. 2014 Jul 16;9(7):e100674. doi: 10.1371/journal.pone.0100674. PMID: 25029507; PMCID: PMC4100736.
30. Mohr DC, Siddique J, Ho J, Duffecy J, Jin L, & Fokuo JK. Interest in behavioral and psychological treatments delivered face-to-face, by telephone, and by internet. Ann Behav Med. 2010, 40(1), 89–98. doi:10.1007/s12160-010-9203-7.
31. Hyland P, Vallières F, Cloitre M, Ben-Ezra M, Karatzias T, Olff M, Murphy J, Shevlin M. Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2020 Jul 6. doi: 10.1007/s00127-020-01912-x. Epub ahead of print. PMID: 32632598.
32. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 2005, 62(6), 617–627. doi:10.1001/archpsyc.62.6.617.
33. Nordgreen T, Haug T, Öst LG, Andersson G, Carlbring P, Kvale G, Tangen T, Heiervang E, Havik OE. Stepped Care Versus Direct Faceto-
Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial. Behav Ther. 2016 Mar;47(2):166-83. doi: 10.1016/j.beth.2015.10.004. Epub 2015 Oct 28. PMID: 26956650.
34. Jolstedt M, Vigerland S, Mataix-Cols D, et al. Long-term outcomes of internet-delivered cognitive behaviour therapy for paediatric anxiety disorders: towards a stepped care model of health care delivery. Eur Child Adolesc Psychiatry, 2020. doi:10.1007/s00787-020-01645-x.
35. College of Psychiatrists of Ireland. Digital Technology in Mental Health Services: Dr. John Hillery & Dr. Bobby Smyth. College of Psychiatrists of Ireland; [cited 23/04/2021]. Available from: https://www.irishpsychiatry. ie/blog/digital-technology-in-mental-health-services-dr-john-hillery-drbobby- smyth/
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2022-01-31
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O’Rourke, N. (2022). Optimising Mental Health in a Virtual World – Connecting from a Distance: College of Psychiatrists of Ireland Medical Student and Intern Essay Prize 2021 Runner Up. Trinity Student Medical Journal , 21(1), 5–7. Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/2164
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