APA Task Force Reviews Digital Tools for Mental Health Care

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The use of digital tools in the assessment and treatment of psychiatric conditions is growing rapidly, spurred on by advancing technology and the movement toward remote models of care.

“These new technologies are generating a lot of excitement, but it’s important for both psychiatrists and patients to understand the evidence supporting their use,” said Phillip Harvey, M.D., a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine.

Harvey is also the co-chair of APA’s Task Force on Novel Biomarkers and Treatments, which recently reviewed the potential and limitations of various digital tools in psychiatric care. The group published their findings in the American Journal of Psychiatry (AJP).

The APA Task Force on Novel Biomarkers and Treatments is a component of APA’s Council on Research that periodically assesses the current state of an emerging area of mental health research. Previous reports by the task force have explored such topics as ketamine, psychedelic therapy, and pharmacogenetic tests.

Harvey told Psychiatric News that for this review, the task force limited its scope to assessments or interventions for psychiatric disorders that can be delivered on personal devices such as phones, tablets, or computers. This includes mental health apps, but also emerging technologies including virtual reality (VR) therapies and technology-based assessments of cognition and functioning.

“Our review of these applications and technologies includes data on their efficacy (when they are employed as treatments or assessment tools) as well as data on user tolerability,” Harvey and colleagues wrote in AJP.

Clinical virtual reality is especially promising on the treatment front, the task force noted. Studies show that VR programs can help patients dealing with trauma, phobias, body image problems, cognitive impairment, and other disorders.

The one regulatory drawback to therapeutic VR programs is that many are tailored to individuals (especially trauma-focused programs); this makes FDA clearance more challenging, as the agency prefers devices to be more standardized across patients, Harvey said. And a lack of FDA clearance may hinder widespread reimbursement of these tools in practice.

Despite this potential obstacle, Harvey said he believes that VR will become increasingly integrated into clinical practice as VR sets become more affordable and portable. Two decades ago, VR machines were clunky devices costing thousands of dollars, but today standalone VR headsets can be purchased for a few hundred dollars.

While VR headsets may still be cost prohibitive for many patients, health systems may one day find ways to use VR systems to expand access to care, Harvey said.

Another area the task force was enthused about is ecological momentary assessment (EMA)—the ability to monitor patient mood and behavior in real time. EMA applications can include passive tracking tools that monitor movement or sleep or active tools like periodic surveys delivered via text messages.

“If you ask a patient to complete a mood diary, you might not get completely accurate information,” he said, noting that factors like recollection bias might influence diary entries. “But if you don’t give someone time to think, they can’t come up with the answer they think you want.”

EMA data are also powerful since researchers can assess multiple points of data in real time and real settings. Harvey recently conducted a study that tracked mood symptoms of individuals with bipolar disorder or schizophrenia over 30 days. The participants were periodically asked to rate their mood while also stating where they were and who they were with. The responses showed that most participants were happier and less anxious when they were out of the house with friends, reinforcing the association between social connections and improvements in psychiatric symptoms.

EMAs “can be used to advance understanding of the dynamic processes underlying psychiatric diagnoses, extending and sometimes challenging prevailing theories,” the task force wrote in AJP.

“There have been several studies showing that these on-the-spot digital assessments do match very well with traditional in-person assessments, and I think they are absolutely there in terms of clinical readiness,” Harvey added.

One critical issue for developers of digital tools to consider moving forward will be equity, the task force noted. While smartphones and computers are becoming more ubiquitous in American households, there are still disparities in technology access among poor, rural, and older adults.

“It’s not so much access to devices anymore; even people in their 80s and 90s are using mobile devices on a regular basis,” Harvey said. “The big thing now is the data plan the individuals have, since these clinical tools often require a lot of data transmission.” He cited the issues with COVID-related remote learning as an example, in which students of lower socioeconomic backgrounds experienced more difficulties in school. ■