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Digital Therapeutics, Mental Health CrisisWhat Are Digital Therapeutics?

Digital therapeutics is a term that can broadly be defined as a treatment or therapy that uses digital and often Internet-based health technology to create, support, and maintain positive  behavior change. Coined as a term in 2012, digital therapeutics (DTx) involves the use of digital products that are evidence-based behavioral treatments delivered online to increase the accessibility and effectiveness of healthcare interventions. They differ from apps in that they typically undergo rigorous scientific testing and approval by groups such as the US Federal Drug Administration. Often grounded in cognitive behavior therapy, digital therapeutics have been developed for the prevention and management of conditions, including ADHD, Alzheimer’s disease, and other forms of dementia, anxiety, asthma, congestive heart failure, depression, hypertension, obesity, substance abuse, Type II diabetes, and many other areas. 1,2,3,4,5,6

How Can Digital Therapeutics Help with the Mental Health Crisis?

Digital therapeutics often serve as standalone preventive or therapeutic behavioral interventions. DTx may also be paired with individual therapy, delivered in-person or through telehealth, either with new or existing clients and patients. They may be prescribed medication when needed. Applications often involve the behavioral component of medical disorders, most often the top five chronic illnesses: diabetes, cardiovascular disorders, cancers, pulmonary conditions, and psychiatry. For example, a patient with prediabetes may be prescribed DTx by a behavioral professional to assist with dietary and exercise changes that are required to avoid a diagnosis of diabetes. Digital interventions are also being used to manage diseases more effectively with complex conditions such as diabetes.

The Need for Digital Therapeutics

The Digital Therapeutics Alliance explains that DTx “… delivers evidence-based therapeutic interventions to patients that are driven by high-quality software programs to prevent, manage, or treat a broad spectrum of physical, mental, and behavioral conditions.” The Alliance is the leading non-profit association dedicated to the evidence-driven advancement of digital therapeutics.

Due to the growing prevalence of mental health issues in the general population, investors poured over half a billion dollars into the mental health industry in 2020, nearly five and a half times more than they spent in 2016. However, mental health access issues persist despite increased investment. The APA findings are supported by other recent reports. Even though virtual care reduces administrative burdens and eliminates geographical barriers, most people who need mental health care still do not receive it.

The quickly growing field of DTx is gaining recognition at a time when behavioral disorders, along with the behavioral component of medical disorders, are at an all-time high. A public opinion poll conducted by the American Psychiatric Association in May of 2021 showed that the pandemic has affected the mental health of 43% of adults, up from 37% in 2020. The United States as well as many other countries face a severe shortage of psychiatrists and other mental health providers. Americans still lack access to in-network therapists, and many counties still do not have psychiatric services. According to estimates by the American Psychological Association and the US Bureau of Labor Statistics, there are remarkably few psychologists in the United States. Recent data show that there currently are only 118,000 psychologists offering direct care in the clinical, counseling, and school psychology areas in the US, which has a population of 331,449,281 people according to the 2020 Census Bureau report.

In short, the demand for mental health services is increasing across the United States, but the current supply of mental health professionals is just not enough. Experts then are increasingly looking to DTx to help address the ongoing mental health crisis.

Medical Digitalization: A New Perspective

The National Institute for Health and Care Excellence (NICE) and the American College of Physicians (ACP) suggest behavioral therapy for most mental health issues. While this is nothing new to most allied behavioral health professionals, it may be affirming to see the larger medical groups publically acknowledge the critical role played by non-medical behavioral professionals, including psychologists, social workers, counselors, addiction professionals,  and behavior analysts, as well as psychiatric nurses and behavioral nurse practitioners.  CIGNA estimated that telebehavioral health services were the most popular telehealth specialty in 2020, and has continued into 2021. TBHI reported in 2018 that 85.4% of all telehealth billed to the Centers for Medicare and Medicaid Services involved a mental health diagnosis in 2016. See CMS Congressional Report: 85.4% of all Telehealth Providers Used Mental Health CPT Codes for details.

Digital technology is now making it possible to deliver behavioral solutions that are both effective and engaging. Through software and digital therapeutics, it is now possible for all these professionals to work as teams using integrated health approaches to offer safe and effective non-drug alternatives to help fill the gap.

Digital Therapeutics: Solving Complex Healthcare Challenges

In-person therapy, teletherapy, and drugs will continue to play an essential role in health care delivery. Nonetheless, it has become increasingly apparent that these solutions are insufficient to address the current mental health crisis in the United States and abroad. The digital health field’s explosive growth during the COVID-19 pandemic has helped DTx find ready markets for their products, but the young sector faces regulatory and reimbursement challenges. The widespread adoption of DTx is an inevitability though, given that Implementing more digital solutions makes it possible to provide a wider reach than in-person care alone, at a time when the demand for care is unprecedented.

Digital care is about delivering measurable, consistent results efficiently and effectively. DTx uses easily scalable technologies to reduce health challenges by providing actionable and intelligent data-driven care driven by real-world insights. Only clinically validated digital solutions driven by digital therapeutics and backed by science, and compliant with FDA regulations will help address the mental health crisis for good.

References

1 Abbadessa, G., Brigo, F., Clerico, M., De Mercanti, S., Trojsi, F., Tedeschi, G., … & Lavorgna, L. (2021). Digital therapeutics in neurology. Journal of Neurology, 1-16.

2 Carl, J. R., Jones, D. J., Lindhiem, O. J., Doss, B. D., Weingardt, K. R., Timmons, A. C., & Comer, J. S. (2021). Regulating digital therapeutics for mental health: Opportunities, challenges, and the essential role of psychologists. British Journal of Clinical Psychology.

3 Hong, J. S., Wasden, C., & Han, D. H. (2021). Introduction of Digital Therapeutics. Computer Methods and Programs in Biomedicine, 106319.

4 Lord, S. E., Campbell, A. N., Brunette, M. F., Cubillos, L., Bartels, S. M., Torrey, W. C., … & Marsch, L. A. (2021). Workshop on Implementation Science and Digital Therapeutics for Behavioral Health. JMIR Mental Health8(1), e17662.

5 Pinto, Melissa D.; Greenblatt, Amy M.; Hickman, Ronald L.; Rice, Heather M.; Thomas, Tami L.; Clochesy, John M. (19 March 2015). “Assessing the Critical Parameters of eSMART-MH: A Promising Avatar-Based Digital Therapeutic Intervention to Reduce Depressive Symptoms”. Perspectives in Psychiatric Care52 (3): 157–168. doi:10.1111/ppc.12112.

6 Williams, A. M., Phaneuf, D. J., Barrett, M. A., & Su, J. G. (2019). Short-term impact of PM2. 5 on contemporaneous asthma medication use: Behavior and the value of pollution reductions. Proceedings of the National Academy of Sciences116(12), 5246-5253.

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