EDITORIAL

published: 27 February 2020

doi: 10.3389/fpsyt.2020.00111

Editorial: Digital Interventions in

Mental Health: Current Status and
Future Directions
Elias Aboujaoude 1*, Lina Gega 2, Michelle B. Parish 3 and Donald M. Hilty 3
1 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States, 2 Department of

Health Sciences & Hull York Medicine School, University of York, York, United Kingdom, 3 Department of Psychiatry and
Behavioral Sciences, University of California, Davis, Davis, CA, United States

Keywords: telemedicine, digital mental health interventions, virtual reality therapy, artificial intelligence,
computerized cognitive behavior therapy, telepsychiatry, electronic health record - (EHR), internet addiction

Editorial on the Research Topic

Digital Interventions in Mental Health: Current Status and Future Directions

An honest supply-and-demand assessment of mental health services in 2020 leads one to conclude
that treatment needs would be impossible to meet without increased leveraging of technology.
Several inherent factors make mental health interventions particularly well suited to digital
platforms: pronounced provider shortages; reduced reliance on examinations and testing; the
stigma still attached to mental illness; and diagnosis-specific obstacles to visiting mental health
clinics (1). As such, various technology-enabled platforms have been tested to support mental health
treatment delivery, from internet-mediated video-based psychotherapy to virtual reality (VR) and
artificial intelligence (AI) enabled programs. Yet the reach of digital mental health interventions
Edited and reviewed by:
(DMHIs) still falls short of its touted potential (2).
Wulf Rössler,
Charité Medical University of Berlin,
Internet-delivered cognitive behavioral therapy (ICBT) may be among the best-studied DMHIs
Germany (3). It has been used for nearly 20 years, during which it has been subjected to several efficacy trials.
To determine more reliable response rates, Andersson et al. conducted an individual patient data
*Correspondence:
Elias Aboujaoude meta-analysis, comprising 29 Swedish trials enrolling 2866 participants, and covering three
[email protected] categories of conditions: anxiety disorders, depression, and other. Overall, 65.6% of all clients
receiving ICBT responded, and about a third achieved remission. More symptoms and female sex
Specialty section: increased the likelihood of improvement, and having an anxiety disorder seemed to decrease it.
This article was submitted to Children, adolescents, and young adults have received particular attention with respect to
Public Mental Health, DMHIs. As “digital natives,” might they engage with, and benefit from, technology-enabled
a section of the journal treatment more than those who did not grow up with technology? Garrido et al.'s meta-analysis
Frontiers in Psychiatry
focusing on young people with anxiety and depression suggests that DMHIs—in particular
Received: 27 January 2020 supervised DMHIs rather than standalone self-help—outperform “no intervention” but do no
Accepted: 10 February 2020 better than active alternatives (e.g., face-to-face therapy). Surprisingly, adherence of young people
Published: 27 February 2020
with DMHIs was generally low, mirroring reviews on DMHIs in adults (4, 5).
Citation: Other sub-populations that have received research attention include army veterans, older adults,
Aboujaoude E, Gega L, Parish MB and
and patients in Latin America. Boykin et al. examined the use of video-based therapy in the
Hilty DM (2020) Editorial: Digital
naturalistic setting of a clinic serving US veterans with post-traumatic stress disorder. In 74 veterans
Interventions in Mental Health: Current
Status and Future Directions. receiving at least one session of video-delivered cognitive processing therapy (CPT) or prolonged
Front. Psychiatry 11:111. exposure (PE), the completion rate was higher for CPT, but attrition by session 7 was 50% (similar
doi: 10.3389/fpsyt.2020.00111 to in-person treatment in this population).

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Aboujaoude et al. Editorial: Digital Interventions in Mental Health

Among older adults, the use of DMHIs comes with unique potential niche and pitfalls in mental health, specifically? In
obstacles and advantages. Seifert et al. dissect those in an opinion their viewpoint article, Miner et al. discuss how conversational
article that focuses on healthcare inequalities and how, AI may impact psychological and psychiatric care at the level of
depending on awareness, training and public health priorities, diagnosis, information gathering and treatment, and propose
new technologies can serve to either mitigate or magnify the four possible approaches as guideposts that inform future
disparities that already exist across the age spectrum. research and policy.
As a region, Latin America suffers from unique access-to-care Mental health interventions, digital or not, have to be
challenges, but the territory also enjoys relatively good internet and documented in patient records held by clinical professionals
smartphone penetrance (6), making DMHIs a possible solution. In a and health services. In their opinion article, Strudwick et al. argue
scoping review of 22 studies that cover prevention, treatment, for opening up these records to patients on the grounds of
education, and symptom self-management, Jiménez-Molina et al. empowerment and autonomy. The electronic health record now
explored the potential for leveraging internet-based interventions in in common use greatly facilitates this process, yet patient portals
mental health in Latin America. Results from the three RCTs still often limit access to mental health notes for reasons and
identified were mixed, and, while most feasibility and pilot studies controversies elucidated by the authors.
showed reasonable acceptability, participant retention was Finally, DMHIs represent potentially beneficial uses of technology
challenging, follow-ups were short, and data on costs and in mental health. A parallel and similarly rich body of research has
outcomes were limited. The authors conclude that more evidence focused on the negative aspects of technology, including addiction,
is required before DMHIs can be considered a realistic remedy to gaming, cyberbullying, and online impulsivity. However, these two
access and delivery problems in Latin America. areas of scholarship have grown in mutually insular ways with little
But DMHIs do not have to replace traditional care altogether; cross-fertilization, despite some shared commonalities that
they can also play a role alongside or preceding traditional Aboujaoude and Gega explore in a perspective piece. Collaboration
treatment. In a UK study, Duffy et al. tested a stepped care between researchers in both camps is essential if we are to reach a
model for treating 124 patients with severe depression and more complete understanding of the issues lying at the technology-
anxiety using ICBT as a prequel for a high-intensity face-to- psychology intersection.
face intervention. Significant reductions were noted across Overall, the studies and articles included in this special issue
primary outcome measures from baseline to ICBT treatment suggest that outcomes with DMHIs are comparable with
exit, and from ICBT exit to service exit. Results support the use of traditional offerings; that some under-researched populations
ICBT as a means to reduce frustrating waiting times and are receiving much needed attention; and that enthusiastic
enhance efficiency. interest animates clinicians and industry professionals to apply
Another example of DMHIs working “with” traditional the latest digital developments, including VR and AI, to mental
treatments may be the use of assistive technologies to address health diagnosis, symptom-tracking and treatment. However,
specific deficits within a disorder that contribute to functional plenty remains to be done to address some basic shortcomings
disability. In a multinational study involving 243 participants, that are borne out in the present issue, including: adherence and
Cerga-Pashoja et al. tested an open-source text simplification engagement challenges; access to technology obstacles; lack of
tool designed to help people with autism spectrum disorder cost effectiveness data; lack of long-term research; and the
better comprehend complex texts, metaphors and idioms—a paradoxical process by which digital tools can sometimes serve
common challenge in this condition. The tool significantly to fortify rather than diminish healthcare inequalities. Given the
enhanced functioning. relatively capped supply of traditional mental health treatments,
The future of technology-enabled treatment in mental health and the ethical imperative to meet the ever-increasing demand,
is probably best captured in the VR and AI “revolutions” DMHIs are likely to be an unavoidable part of any solution to
unfolding within the larger space of DMHIs. VR has been treatment access issues. This special issue highlights the dizzying
tested for its possible therapeutic value in mental health for diversity and richness propelling the field of DMHIs as well as
almost as long as it has been exploited for gaming purposes—a the limitations still holding it back. Further rigorous, yet
quarter century (7)—but research into VR treatments has pragmatic, research—across platforms, populations, diagnoses
accelerated considerably in recent years, particularly for and interventions—is needed to arrive at a more realistic
anxiety disorders. Yet VR's reach remains limited among assessment of the true potential of DMHIs.
patients and therapists (2), a fact that Boeldt et al. dissect in
their opinion piece, suggesting educational, practice-based and
research steps to take full advantage of what VR therapeutics
have to offer.
AI and machine learning are seen as transforming fields like AUTHOR CONTRIBUTIONS
radiology and pathology (8, 9), and, in medicine, more broadly,
they hold the promise of bringing individualized low-cost EA, LG, MP, and DH contributed to the design, review and
interventions that can be easily scaled. But what is their editing of the Research Topic and to the editorial summarizing it.

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Aboujaoude et al. Editorial: Digital Interventions in Mental Health

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