Two weeks ago, Angela went to her therapist’s office for her regular appointment. This week, it happened over a secure video chat.
“It’s the first time I had heard of teletherapy,” she says. She’s anxious, and increasingly so with the dire coronavirus news. “It hasn’t kicked in or fully set in yet” that this is her—our—new reality.
The coronavirus outbreak has forced millions of us to isolate ourselves, sometimes even within the same house, from those we interact with every day: coworkers, friends, family, pets. Combine that with existential fear and a looming unknown future, and it’s understandable that anxiety is high.
No wonder, then, that mental health apps—ranging from meditation and wellness helpers like Headspace and Sanvello to teletherapy platforms like Talkspace—have spiked in use.
Headspace’s chief science officer, Megan Jones Bell, says there’s been a 19-fold increase in people downloading stress-relieving meditations, with a 14-fold jump in those intended to relieve anxiety. The company has launched a free set of meditations called “Weathering the Storm,” made specifically for dealing with the crisis.
Mental health app Sanvello has responded similarly, releasing its premium content for free. Monika Roots, Sanvello’s chief medical officer, says the app’s mood tracker started seeing “mentions” of the words “Covid-19” or “coronavirus” on January 22, the day President Trump told CNBC the virus was “totally under control.” By February 16, “mentions of it [coronavirus] were up 157% a week [from the week before],” Roots says. “By the last week of February, they were up 509%. And by the week of March 9, mentions were up 605% from the week previous.”
Meanwhile, Amy Cirbus, a New York–based therapist who offers services through Talkspace, says her user volume is up 65% since last month, which she attributes to coronavirus fears. “People are concerned about how this will affect them and their families as well as dealing with a new norm and social isolation,” she says.
Changes in regulations are also making it easier for people to access mental health care online. Earlier this week, the US Department of Health and Human Services relaxed constraints that had previously made it nearly impossible to meet digitally with a doctor because of privacy concerns under the Health Insurance Portability and Accountability Act (HIPAA). That could be a game changer, even once the current pandemic has subsided.
“I think this will fundamentally change how people see telehealth broadly,” says Reena Pande, the chief medical officer of AbleTo, a teletherapy platform that counts over 700 clinicians across the US. She says that in the past week, requests to connect with a professional have increased 25%.
But while mental health apps make advice and care easier to access, are they as good as traditional in-person counseling? “These apps help augment care or extend it,” says John Torous, the director of digital psychiatry at the Harvard-affiliated Beth Israel Deaconess Medical Center. “When they’re used as standalone tools or as single interventions, there’s good evidence from meta-analyses that they might not be as effective, or not enough as treatment alone.”
A 2012 study in JAMA found that patients who got over-the-phone cognitive behavioral therapy and those who met with a therapist face to face both saw improvements in depression, but with some differences. While more of the telephone therapy group stuck with therapy, a higher proportion of them had slipped back into depression six months later. The face-to-face group had a slightly lower rate of sticking to therapy but was more resilient.
Another issue is that it’s difficult for consumers to have confidence in how effective an app might be. Many mental health apps market themselves by citing scientific studies. “But these studies are often of lower quality, like comparing apples to oranges,” Torous says. That’s not to say that the apps are harmful, but the marketing might overpromise. A 2019 study in the Journal of Medical Internet Research found that less than 2% of app makers’ claims were evidence-based, and that more than 50% of claims about easing anxiety or depression could not be substantiated. “A lot of them say they’re based on cognitive behavioral therapy,” he says. “But we don’t know how they’re translating that. It’s like saying ‘If you love the books, the movie is going to be great!’”
Nevertheless, the relaxation of HIPAA rules around privacy means apps are uniquely poised to make a dent in mental health care. It should make teletherapy more attractive not only for consumers but for providers, potentially widening access.
And there is some evidence that apps with a human being at the other end can be pretty effective. The 2019 study found that when an app involved therapy or other interaction with another person, engagement rates rose, and people found more benefit than if they simply listened to a recording or tracked their mood, says Torous.
Angela felt awkward about her appointment. Her neighbors were around, and her husband has been working from home with her, which made being completely open and connected difficult. “I didn’t feel the safety I typically feel in their office,” she said. “It wasn’t a bad [Wi-Fi] connection, it was just difficult to get the connection you get in person.”
It’s still unclear what the future of mental health care will be in a world where self-isolation might last for long period and the only way we can connect with others is via a digital device. Smartphones aren’t just a potential gateway to mental health care; they could also radically transform what it means to go to the doctor’s office.
What is clear is that the relaxation of HIPAA constraints could lead someone who might not otherwise have been comfortable seeking mental health care to do so through a digital device for the first time. At such a stressful time, that might be enough.
“I think this could be the moment in the history of psychiatry where we’ll see people increase their access to mental health care,” Torous says.
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