Could digital interventions be used to treat depression?

When people think of virtual reality, they often associate it with games or science fiction. But could this technology also be used in the treatment of depression?

In a recent study cited by, amongst others, BBC news, Dr Caroline Falconer and colleagues showed that putting patients with clinical depression through a series of virtual reality sessions, in which they were taught ‘self-compassion’, reduced their depression. Cultivating self-compassion has previously been shown to reduce depressive symptoms by countering destructive and maladaptive thought patterns. The study by Dr Falconer and colleagues built upon this research and used virtual reality as a novel method to facilitate this process.  While their results still need to be validated in a large sample study, this is one of many examples of how researchers and healthcare bodies are exploring new technologies for the improvement of healthcare services.

Another example of technological innovation for health care is the rise in the development and use of ‘health apps’. In 2013, NHS England launched a pilot website to host apps designed to help patients with a variety of conditions. While the original site has temporarily closed amidst concerns regarding the potential leak of personal and health data, a NHS England site containing information on digital interventions and health apps specifically for mental health patients is still active. NHS England’s investment into such a pilot demonstrates the willingness of payers to explore new modes of delivering healthcare interventions for patients with depression.

Current clinical guidelines recommend that depression is treated by traditional ‘talking therapies’ coupled with pharmacological interventions. However NICE also recognises computerised CBT as a treatment option for patients with mild to moderate depression. In addition to potential cost-savings compared to face-to-face therapy, digital interventions could hold several benefits over traditional psychotherapy. As noted by Dr Falconer, whose research focusses on the use of digital interventions for mental health patients, digital therapy could be especially appealing to younger patients who are familiar, and more comfortable, with digital technology than older patients. Furthermore, using digital interventions could potentially increase adherence to therapy by removing the potential stigma or discomfort associated with attending a mental health centre.

However, Dr Falconer also notes that the use of digital interventions for the treatment of depression or other psychopathologies still requires more research. Currently, there are few published meta-analyses that investigate what digital interventions that work best and what patient subpopulations that are most likely to benefit from them. Furthermore, while it is often claimed that digital intervention could decrease the costs to the NHS through reduced therapist time, it is unclear whether this claim truly stands up to scrutiny. For example, if a digital intervention consists of a remote therapy session rather than a healthcare app, the number of therapist hours needed is likely to be the same as in traditional face-to-face therapy sessions. Further, to ensure adherence to digital interventions delivered over a long period of time it might be necessary to build in support from a therapist as this has been shown to increase patients’ engagement with the therapy. As a result of these, and other, factors, the potential cost-savings are likely to vary between different types of digital interventions.

Nonetheless, there is huge potential for the use of digital interventions as supplementary treatments for depression. With the surge in digital healthcare research we can expect our understanding of what digital interventions are effective, why, for whom and under what circumstances to increase.  But this begs the question:  will doctors be willing to prescribe apps instead of medication?