App vs Therapist: How the digital age is transforming therapy

Mental health care has seen significant funding cuts in recent years, leaving many without adequate help. Apps and other digital solutions offer to plug the gap, but can they actually offer real human support?

Mental health care has become an increasingly common and de-stigmatized imperative, thanks in most part to a continuum of campaigning that includes everyone from grassroots activists to the Royal Family. But what does the therapist’s couch look like in the digital age? And how has our access to it changed over the years?

“Therapy culture in the UK is very conservative around technology,” says Dr Charlotte Cooper, a London based psychotherapist. “Having a website is still    seen as somewhat daring.” There are a number of reasons for this, she explains.

“Therapy is one of the few professions in which older women can thrive as practitioners. This means that many therapists are not digital natives or early adopters of computers and the internet and are much more comfortable communicating offline.”

A lack of confidence or skill in using technology reflects the lack of investment in women in tech more broadly, says Cooper. “Plus, therapy training is not geared towards the working life of a therapist, and many practitioners are relatively unskilled in using social media or online resources to build a practice. This stale thinking also makes practitioners vulnerable to duff services.

“For example, I pay an extortionate £76 per year – on top of my other membership fees – to be listed in my professional body’s online database of therapists. For this I get a page that barely reflects the values and qualities of my practice, that I cannot customise, improve SEO, edit very easily and for which my returns are minimal compared to my own marketing elsewhere.”

Practitioners will do all they can to preserve the integrity of therapy’s relational nature, says Cooper.  “For example, some practitioners refuse to use email; they insist on speaking on the phone to arrange things because they believe it is essential to hear a client’s voice in order to build a sound therapeutic relationship.   Professional bodies are very cautious about causing no harm, and rightly so, but they’re not necessarily in sync with therapy clients, who are getting increasingly younger, and for whom internet technology is a fact of life.”

Rethinking smartphones

As studies show, anxiety has been at epidemic levels for some time, particularly across Generation Y. There are numerous factors behind this spike in distress; chief among these includes the 24-hour newsfeed. In the UK, the Mental Health Foundation have recently reported receiving a five-fold increase in traffic to their online anxiety page, a surge that began last July: the month following the EU referendum vote.

“Phones and social media keep us connected to the shifting currents of world and home political affairs, making it much harder to maintain boundaries and take healthy time out from anxiety-inducing news,” explains the charity’s senior media officer, Carl Strode.

While many in the therapy industry are asking us to rethink the way we use smartphones, others are hoping our devices may, ironically, offer a solution. Talkspace, a US-based online counselling app that launched in 2012, is reaping lucrative rewards out of American anxiety.

National distress around the 2016 presidential campaign and inauguration of Trump saw the start-up – which charges uses a monthly fee to connect with therapists via texts and video sessions – growing 70-80% faster than projected, according to CEO and co-founder Oren Frank, a swell made up mostly of millennials in the 33-34 year-old age bracket. LGBT people, Jewish people, Muslim Americans and women make up the lion’s share of Talkspace’s traffic.

“We think psychotherapy is something everyone and anyone should have access to,” says Frank. But are apps like Talkspace truly beneficial to their users, and the therapists they employ? Cooper thinks not. “They offer very low rates of pay and practitioners have to be available at all hours. Plus, texting is so limited. Apps like this are the Uberification of therapy.”

Digital stand-ins: help or hinder?

Apps like Talkspace are proving big business in the UK.  In April, NHS England announced plans to invest £70m in digital mental health services. Online CBT programs, used to treat depression, anxiety and panic disorders, are an increasingly common feature on the NHS App Library. Some of these are free, while others are fee-based, and while some allow users to connect with a human, most do not.

Browse the NHS site and you’ll find apps like Big White Wall, a Facebook-slash-study-course style platfom for people with depression and anxiety, overseen by human ‘guides’; Buddy, a diary-like app to help spot patterns in mood and behaviour; Fearfighter, a CBT-based self-help course for panic and phobias; Leso, a live, confidential, IM-assisted CBT course for depression, pain management, OCD and stress management and Sleepio, a module-based tracker-style course for sleep issues such as insomnia.

There’s little-to-no proof that the majority of these digital stand-ins actually work

While apps like the aforementioned proliferate, encouraged into life by large, profitable NHS contracts, demographics that might have troubling accessing these technologies – the elderly, the neurodiverse and second-language English patients – seem conveniently forgotten. There’s also little-to-no proof that the majority of these digital stand-ins actually work. And after the recent ransomware attack on the NHS, concerns around confidentiality and government data protection seem particularly salient.

Even the most benevolent, non-profit therapy apps can fail – and even harm, as the Samartians found out in 2014. Their app, Radar, was designed to read Twitter users’ content for evidence of suicidal thoughts, and then alert the user’s friends and family. On paper, Radar was a way of turning “your social net into a safety net”; in reality, the app felt to many like an invasion of privacy, and a chance for bullies and stalkers to weaponize sensitive information against their targets. After heavy criticism, the charity abandoned the app.

Plugging the funding gap

Many experts, including Emma Broglia, a PhD student at the University of Sheffield, are voicing concerns around this wave of e-therapy business. “The issue is that these apps are designed by developers who do not have a therapeutic or clinical background, and very few have been the subject of clinical trials,” she points out in industry publication, Therapy Today.

What is clear is that the NHS is operating under increasingly untenable means, decimated by underfunding, mismanagement and privatisation. The annual estimated cost of mental health care in the UK is around £100bn per year, and since that extra £3.5m we were promised by the Brexit camp seems unlikely to materialise, crude tech stand-ins are being used to plug the gaps that record waiting times are creating.

They herald poor working conditions for therapists, says Cooper, which in turn means poor services for clients. The premise – that apps can adequately replace in-person therapies – is “total neoliberal nonsense in an austerity climate that is trying to de-fund health services and palm off cheap useless interventions on poor people. The rich still get their four-times-a-week, years-long psychoanalysis in Hampstead, of course.”

Developers and providers tell us these apps are indispensible because they’re available around the clock, on any device; that they make travel unnecessary, a boon for people who are ill, immobile or unable to travel due to financial, geopgraphical and/or mental health reasons. Cooper sees some of her clients via Skype, and while screen-based therapy may be a boon for some, it should never be the only available option.

The value of spontaneity

 While some feel liberated by the mask of an avatar, others find them a real barrier. Evidence proves that screens can seriously impede the therapy process. As psychoanalyst and author Dr Gillian Isaacs Russell points out, 60% of communication is non-verbal.

“That implicit, non-verbal communication that is central to what you do in the consulting room isn’t going to happen in the same way online,” she warns. “Presence is a core neuropsychological phenomenon – it’s an organism’s capacity to locate itself in the external world, and the ability to interact with another in a shared physical environment enables the nervous system to recognise that it is in an environment outside of itself that is not a dream state or a product of its mind. The experience of embodiment in a shared environment is essential to our experience of being.”

In mediating the care of our pain via a screen, we’re often attempting to avoid what clinical psychologist Sherry Turkle calls the “messiness” of spontaneous conversation – the very thing that, in talking therapies, can yield the most healing, breakthrough dialogues. We also know that the presence of a phone in social situations, even a switched-off device, can disrupt our capacity to both open up and empathise with others.

How then, given these barriers, can phones and screens truly serve us in a therapeutic context? How much nuanced, holistic care is lost when we attempt to map our complex, unique and frequently unquantifiable needs over modules, scales and multiple choice-style box-ticking exercises? An app in itself isn’t a problem, says Cooper, but as the only accessible source of support for someone in distress, its next to useless.

“Technology that has a better chance of helping people are tools that enable people to think things through collaboratively, in a context where they feel emotionally secure and cared for by another real live person whom they have got to know over time. Skype and instant messaging can be very effective, but they need that human quality of relating behind them; they can’t be treated as a cut and paste job. I also think it’s fine to use things in conjunction with a pre-existing therapeutic alliance.

“Clients might want to talk about their use of therapeutic apps, practitioners might use a tablet in session to draw things or create mind maps. Digital pictures, video and sound can prompt useful therapeutic conversations. Sometimes clients have read emails and texts to me in sessions and we have discussed them together.”

There is a place for technology in therapy, says Cooper, but it must serve clients and therapist alike, and be grounded in evidence and practitioner-based knowledge. Only that kind of technology can truly enrich our mental health care.

DeepMind’s Go-playing AI can learn the game for itself now

Google’s AI subsidiary DeepMind believes it is one step closer to creating AI with general intelligence because its Go-playing software, AlphaGo, has been updated and can now teach itself how to play. AlphaGo Zero was only programmed with Go's basic rules, and from there it learns everything else by itself.

Source: The Verge

UK spies monitoring social media in mass surveillance tactic

The privacy rights group Privacy International says it has obtained evidence for the first time that UK spy agencies are collecting social media information on potentially millions of people. The discovery raises concerns about whether effective oversight of the mass surveillance programs is in place.

Source: TechCrunch

Blue Origin passes hot-fire test

Blue Origin, the aerospace company fronted and largely funded by Jeff Bezos, has released footage of its BE-4 engine's first and successful completion of a hot-fire test. The successful hotfire supports the idea that Blue Origin could in the future be used for orbital and deep space missions.

Source: Ars Technica

5G to be used by 1 billion people in 2023 with China set to dominate

Analysts at CCS Insight have predicted that 5G technology will be in place by 2020, with China being the main beneficiary. "China will dominate 5G thanks to its political ambition to lead technology development," said Marina Koytcheva, VP Forecasting at CCS Insight.

Source: CNBC

Climate change makes it more likely to see hurricanes in Europe

Meteorologists from the University of Bristol have predicted that the likelihood of hurricane-force storms hitting the UK, much like Hurricane Ophelia did this week, will be enhanced in the future due to human-induced climate change.

Source: New Scientist

Russia to launch 'CryptoRuble’

According to local news sources, Russian President Vladimir Putin has said that the nation will issue its own cryptocurrency at a closed door meeting in Moscow. The news broke via minister of communications, Nikolay Nikiforov.

Source: Coin Telegraph

Human habitat located on the Moon that will shield us from its extreme elements

Researchers have discovered a potential habitat on the Moon, which may protect astronauts from hazardous conditions on the surface.

No one has ever been on the Moon for longer than three days, largely because space suits alone can’t shield astronauts from its elements: extreme temperature variation, radiation, and meteorite impacts. Unlike Earth, the Moon also has no atmosphere or magnetic field to protects its inhabitants.

However, in a study published in Geophysical Research Letters, researchers have claimed that the safest place for astronauts to seek shelter is inside an intact lava tube.

“It’s important to know where and how big lunar lava tubes are if we’re ever going to construct a lunar base,” said Junichi Haruyama, a senior researcher at JAXA, Japan’s space agency.

Image courtesy of Purdue University/David Blair. Featured image courtesy of NASA/Goddard/Arizona State University

Lava tubes are naturally occurring channels formed when a lava flow develops a hard crust, which thickens and forms a roof above the still-flowing lava stream. Once the lava stops flowing, the tunnel sometimes drains, forming a hollow void.

The Lava tubes located by Purdue University researchers are said to be spacious enough to house one of the United States’ largest cities, and while their existence – and in particular their entrance near the Marius Hills Skylight – was previously known, their size was previously an unknown quantity.

“They knew about the skylight in the Marius Hills, but they didn’t have any idea how far that underground cavity might have gone,” said Jay Melosh, professor of Earth, Atmospheric and Planetary Sciences at Purdue University.

“Our group at Purdue used the gravity data over that area to infer that the opening was part of a larger system. By using this complimentary technique of radar, they were able to figure out how deep and high the cavities are.”

At the first meeting of the US’ reintroduced National Space Council, vice president Mike Pence announced that the Trump administration will redirect America’s focus to travelling back to the Moon.

Pence’s declaration marks a fundamental change for NASA, which abandoned plans to send people to the moon in favour of Mars under President Barack Obama.

“We will return NASA astronauts to the moon – not only to leave behind footprints and flags, but to build the foundation we need to send Americans to Mars and beyond,” Pence said.