Connecting mental health to the digital revolution

Today’s society is based on the use of new technologies. These have been introduced almost naturally into the daily lives of a large part of the world’s population and have become indispensable in many aspects of daily life. Within this broad concept, we would find the term information and communication technologies (ICT from now on). This would include any type of technology (whether at the level of equipment or software) that allows users to access, store, retrieve, transmit or manipulate information (Belloch, 2012). As you can imagine, this definition leaves a very wide and dynamic spectrum when it comes to limiting terms, since depending on the historical moment in which one finds oneself, we could include different elements in this definition. However, and if we stick to the present moment, it seems right to focus ICT on what is related to digital networks and the latest developments at the computer level, including fields such as robotics and even artificial intelligence.

These technological advances, apart from influencing daily life, have had a great impact on many scientific fields. From the field of psychology, ICTs have been applied in practically all areas such as experimental, educational, social, psychometric and clinical fields (Botella et al., 2007). Within clinical psychology itself, a notable increase has been noted in recent years in interventions and research carried out through or with the help of ICTs (Botella & Breton-López, 2014), always prioritizing the benefit of the patient through the extensive possibilities offered by these technologies. This symbiosis has been reflected both in evaluative aspects and in intervention itself, opening a multitude of possibilities in terms of therapeutic options, ranging from clinical data collection, through mobile apps, to structured interventions based on virtual reality elements, to cite a few examples.

Opportunities for the use of ICTs

These technologies have several advantages in terms of their application in the field of mental health. On a broad spectrum, it is undeniable how standardized and familiar we are as a society with these tools. Concepts such as instant messaging (Whatssap, Telegram) or video calls (Skype, Hangout) are often familiar even to those most disconnected from the digital world.  

On the other hand, many of them are accessible practically at any time or place, having an immediacy in the handling of information never seen before. If we apply it in the therapeutic field, ICT can be an excellent way to bring psychological interventions closer to people who do not have easy access to these services in person (Botella, García-Palacios, Baños & Quero, 2009). This can be really useful in those cases of reduced mobility or at present, with a health emergency that favors people to stay at home due to COVID-19 restrictions. The use of video call programs has allowed the ” almost normal” development of psychological therapies that otherwise would have been irremediably cancelled. At the same time, ICT facilitate the generation of new and efficient evaluation techniques (especially promoting the use of objective measures, due to the symbiosis of these with computer tools) and intervention. Among them we could find treatments for phobias based on exposure therapies with augmented or virtual reality environments, which show an effectiveness close to real exposure techniques (Maples-Keller, Bunnell, Kim & Rothbaum, 2017) and widely improve the acceptance of the therapy. We could also comment on the advantages in the correction and automation of questionnaires and evaluations, which significantly reduce the time needed to pass and correct this type of test.  

Limitations and future challenges

However, although these tools have a good range of possibilities and advantages, they also have certain limitations. First, despite being in a highly computerized society, there are certain people that may have difficulty accessing these tools in a stable manner. For instance, difficult socioeconomic contexts (e.g., people with low economical incomes) may prevent these technologies from being accessed for the purposes described above and on a continuous basis. We could therefore find a digital gap when considering social status which, is particularly serious and challenging in health-related issues. On the other hand, although we are familiar with many of these tools, when applying them in specific fields they may require an additional cost or previous training. This issue may cause problems at the level of integration with professionals, who must be willing to invest the necessary time and resources to take advantage of them. 

In addition, the use of these technologies can have an economic cost that is too high for small clinics or for individual therapists. While in clinical centers with a high demand of patients, we could find logistical problems to properly implement ICT in the daily practice of their professionals. In the clinical setting, the misuse of these technologies could lead to excessive dependency or be used by the patient as a safety feature in an incorrect way. On the other hand, while it is true that ICTs allow us to evaluate more efficiently, other qualitative factors may be more difficult to detect (e.g., non-verbal expressions), in contrast to a face-to-face assessment. 

It should be noted that most of the problems related to the application of ICT are due to their high cost and difficulties in standardization. Meanwhile, these digital tools show a great clinical utility and potential, which is widely endorsed in the clinical field. Therefore, it is to be expected that, with the course of time, these tools will become more accessible and, therefore, will be used more and more in daily healthcare practice. One of the main challenges for the future, however, is providing a greater multidisciplinary involvement to correctly evaluate and validate these tools. That is, to develop studies to evaluate the reliability, validity, efficacy and efficiency of these types of tools. 

Main ICT tools in mental health

On this basis, some of the most outstanding ICT tools that will be commented and carefully explained in the following articles are: 

Virtual Reality (VR): Possibly one of the most representative elements of the application of ICT in mental health. Virtual reality is a promising field within the field of psychology, with applications ranging from research to the treatment of mental health problems (Freeman et al., 2017). Although it was initially used for phobias, its use has expanded to other psychopathologies (Carvalho, Freire, & Nardi, 2010). For example, some of its applications are currently focused on anxiety disorders, drug dependence, schizophrenia, and EDs (Freeman et al., 2017). This technology allows the patient to be introduced into a virtual controlled environment, where he or she can securely interact the virtual environment and stimuli within. This is a revolutionary element in psychological treatment since it allows the patient to improve with respect to his or her problem by having exhaustive control of the variables that modulate it. It is still in the process of expansion in different mental health fields. 

Augmented Reality (AR): Unlike VR where the patient is completely immersed in a virtual environment, in AR the virtual elements are superimposed on the real world. In other words, digital stimuli are added to the real environment. This produces a very high level of immersion in the patient.  The range of applications is similar to that of VR, and can be even more efficient, due to a more economical and simple use. For example, through AR, patients can gradually confront a phobia by exposing them to a virtual representation of their phobic element, which is literally placed on the real environment in which they are.

“Ecological Momentary Assessment (EMA): EMAs are tools used for the continuous collection of data on some patient’ characteristics or behaviors for subsequent use in the therapeutic process (Heron & Smyth, 2010).  It is usually done through some type of PDA (Personal Digital Assistant), electronic journal or more recently, even through the cell phone itself. The distinctive feature of these devices is that they allow the collection of data instantaneously, in the natural context and at the required moments. For example, it is possible to evaluate the degree of anxiety with respect to certain tasks throughout the day, without having to wait to be present at the consultation, which gives an invaluable ecological value to improve the therapeutic process.  

Telepsychology: The American Psychological Association (2013) defines telepsychology as the provision of psychological services using ICTs, through the processing of information by any electronic or digital means. As previously mentioned, telepsychology allows sessions between therapist and patient to be carried out telematically through video call applications. Although it can be done simply as an adjunct to face-to-face therapy, lately it has acquired a relevant role as the main therapy format due to the health problem generated by COVID-19. This technology allows the possibility of continuing the therapeutic process in a normal way, even in those contexts with reduced mobility. On the other hand, it can also help to accelerate the processes that require a quick interventions, and/or allows patients who cannot travel to the center to receive psychological attention as well.

Serious Games: The concept of “Serious Games” refers to the use of video games that have a therapeutic purpose, such as acquiring skills, advancing a therapeutic process or improving the understanding and acceptance of a problem (Giunti et al., 2015). These video games are usually created specifically as a therapeutic tool, although there are cases in which “commercial” video games can be used for this purpose due to the way they are developed. This type of tool can greatly facilitate the “engament” of certain types of patients in the therapeutic process. It is an expanding field in psychology and can cover a large number of therapeutic processes (Lau, Smit, Fleming, and Riper, 2017), being currently widely used in child and youth psychology or related fields such as education.

Robotics: At present, studies and pilot tests are already being carried out to test the effectiveness of using robots as a therapeutic element or as a support element in different problems throughout a person’s life. Although there is research at all ages, its use in children with problems such as autism spectrum disorders, seem to work particularly well. For instance, to help them in the management of emotions and sociability (Marchetti, Di Dio, Manzi, and Massaro, 2021).  On the other hand, several tests have been done in inpatient clinical treatments to improve the quality of the stays and to improve the patients’ coping with the different hospital processes, giving positive results that imply promising results in future lines of research. 

Artificial Intelligence (AI): The study of AI is an expanding field in a wide variety of scientific disciplines, seeking to generate logical and automated processes, to generate new learnings and information. In the field of psychology, it is a novel research line that would allow to accelerate and automate many clinical processes. Resulting in a notable  ease the care burden of mental health services (e.g., in the management of evaluations). Currently, there is an interesting debate about its application in clinical psychology, and particularly whether is it appropriate to use AI to improve the therapeutic process (Horn & Weisz, 2020). On the other hand, the possibilities of using AI in clinical decision-making processes are being contemplated (Luxton, 2014), although its possible technical and ethical implications continue to be discussed.

References

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