“How do you feel today?” It’s a common question, and for some people an answer rolls off the tongue automatically – perhaps something non-committal and socially appropriate, like “I’m fine” or, “Okay”. In fact, this happens so often that I’ve gotten into the habit of asking again, which is usually met with confusion. It seems surprising to people to realise that someone isn’t just being polite, but genuinely wants to know how they are. It catches them off guard, it encourages consideration and introspect, and sometimes the answer is quite different the second time. So, how do you feel today?
What would be different about your day if you felt much better, or a lot worse than you do? Do you prioritise things like mood, wellbeing, and mental health in your daily schedule? And if not, what stops you? Would you be more likely to factor it in if you had the time, or could easily access resources?
In the information age, it’s pretty appealing to push something fluffy like wellness to the bottom of the pile. After all, there are real things that need doing, like, right now, and that iPhone full of deadlines and business emails will not stop buzzing.
But what if technology didn’t have to be a barrier to looking after our mental health? What if the two could work together, and create a new way of experiencing the world for every single person on it?
If we look a bit closer, we can see how valuable technology has become for our psychological needs – and how promising the future for mental health care might be if we take advantage of the digital revolution.
Is This Really Relevant?
To many, the mention of psychiatry conjures the image of a doctor in a sweater-vest (probably a dude with a goatee) nodding gently and taking notes as the patient lay on a chaise lounge looking at Rorschach paintings. I hope we can move away from these antiquated ideas, because we now know it’s about so much more – every person is a unique puzzle of physical and mental wellness. We need to consider not only diagnoses such as anxiety and depression, but their personality, mood, functionality, social identity and overall wellbeing.The paternalistic view of medicine can be quite intimidating and has likely contributed to a global reluctance to ask for help. Studies have identified that less than 35% of adults and less than 20% of teenagers experiencing a mental issue engage with a professional service. Contributing factors to these percentages include stigma toward mental health, fears about confidentiality, lack of accessibility to services, and lack of awareness about what services are available. When one in three people will experience anxiety or depression throughout their life, it seems a tragedy that such a vast number of them may struggle for years because they didn’t know help was available, or how to access it.
It doesn’t help that on a worldwide level mental healthcare is still grossly underfunded, with limited provisional flexibility and rising costs. In contrast, the Internet is now seen as a basic commodity to many. In 2013, 80% of the global population owned a mobile phone, including those in the developing world. To put this into perspective, in Australia for every 100,000 people there are 80,000 mobile phones but just 9 psychiatrists. It’s tempting to look at a statistic like that and just throw my hands up in the air and go down the pub in defeat. And yet I can’t help but feel that it is really an enormous, exciting and exhilarating world of potential. Is it possible that, for the first time in human history, we can provide mental healthcare services to just about anyone? Even those in highly remote areas, developing countries, or to whom local resources are financially inaccessible?
Dr Google
I wanted to find out if clinicians had begun incorporating technology into existing healthcare models, so I started with a literature review. Turns out users have been integrating technology into their management of mental wellness since pretty much day dot.More than half of young people have used the Internet to find help for a personal problem. The vast majority – a whopping 94% – felt satisfied with the information they found online.
Considering how volatile the internet can be, that’s really, really awesome.
And it makes sense. The internet is a space that allows literally anyone – even those who are isolated or marginalised – to be part of something, to have access to information about almost anything, and to network with people they would never have had the opportunity to meet even twenty years ago.
The anonymity, (relatively) low cost, and the ease of accessing information has made the internet a great resource for users with stigmatized diagnosis such as depression or anxiety, who are more likely to seek help online than they are by conventional methods. And for specific individuals, socialising online can have a range of benefits. Many learn transferable communication skills and develop long-lasting tangible friendships through online video games.
In a survey of World of Warcraft players, almost half stated they would be more likely to discuss sensitive issues with their online friends than those offline.
There is an increasing body of work focussing on the possible benefits of video games. They are designed to be motivating – to keep the player sufficiently challenged and rewarded, meeting that perfect balance which makes playing a game enjoyable. Through accessing the flow state, providing a sense of competence, and promoting the physiological release of a neurotransmitter called dopamine, this can have a positive impact on the player’s wellbeing. In fact studies agree that video games can be used as an adaptive coping strategy for stress, that they improve mood and emotional stability, and can have creative and social benefits.
So if video games, smart phones and internet access have accidentally been helping people with their mental health for years, can we go one step further? Could creating electronic treatments smash the remaining barriers to recovery?
Technological Therapy
On paper, e-treatments are a great way of tackling a lot of the traditional roadblocks users will have encountered when seeking help for their mental health and wellness. They’re cheap. They’re easily accessible. They’re versatile. They’re motivating. But do they work? Having looked at a few meta-analyses, there are certainly areas which stand out in terms of viability.A decline in cognitive function can be linked with depression. This is particularly true in the older population, but using brain training games has been shown to preserve cognitive function and improve their mood and wellbeing. The awesome thing is that the change has been shown to be long-lasting.
Cognitive Behavioural Therapy (CBT) is a traditional, evidence based and effective treatment for many conditions. It sometimes involves work in groups, and can be reasonably time intensive, so some people may choose to opt for game-based CBT or e-CBT, which have been shown to be just as effective for depression and anxiety disorders. Like most therapies in psychiatry, outcomes are best when several treatments are combined, such as medication and therapist time. And perhaps in the future, we can add the Oculus Rift to the mix, seeing as VR has been proven to be a valid adjunct to traditional CBT.
That’s not all VR technology is good for, either – a well renowned treatment for anxiety disorders such as specific phobias, social anxiety and PTSD, is a technique called “flooding”. This is essentially reintroducing the user to the stimuli that induce their symptoms in a controlled and safe way whilst learning how to manage those feelings. Multiple centres are looking at VR to provide this immersive and convincing experience.
In fact there are groups developing specific resources using modern technology all over the world. SPARX is a computerised CBT for adolescents with depression and anxiety and has had positive feedback from study subjects. Similarly in Europe a game is being developed for impulse disorders such as anorexia and bulimia. This endeavour involves biofeedback, an exciting new direction for healthcare, but particularly in mental health which has traditionally been segregated from the physical body.
In Australia, the Black Dog Institute has a variety of technological initiatives. These include a school prevention programme to educate children about mental health and accessing help using games, apps and websites. And perhaps my favourite idea yet – an app which delivers risk information about the user by analysing their behaviour on social networking services such as Twitter and Facebook. It could look at their frequency of use, their tone, social engagement, and language, to consider things such as suicide risk and mood changes.
Technology has the potential to provide some really cool, evidence based, and viable resources for information, support and even treatment for mental health conditions. In fact, when it comes to wellbeing, we are already using technology to enhance our life experience. But I believe it can go further and faster. Tech can provide a revolutionary opportunity for care in particular communities. It can make healthcare accessible on a global scale. We can make it quicker, easier and cheaper for anyone to get the help they need.
There’s certainly a lot of additional research that needs to be done to ensure that this is safe and valid, so we’ll call it a work-in-progress. But in the meantime, there are things we can do as a community to reduce stigma and raise awareness. It could even be something small, like asking a friend, “How are you feeling today?”
