Harnessing technology to provide therapy for depression

20170512150000, Wei Wei Lee
Psychologist sitting on armchair
The World Health Organisation estimates that depression is the leading cause of disability for people in midlife and for women for all ages.
According to the Institute of Mental Health (IMH) of Singapore, 1,800 new patients have been diagnosed with clinical depression in 2015, an increase of about 7% from 2014. The numbers of new patients for the past three years have been mostly constant, averaging a 7% increase annually.  

In fact, in the Singapore Mental Health Study conducted by IMH in 2010, data showed that as many as one in 17 people have suffered from a major depressive episode at some point in their life.  

This is not a problem confined to Singapore. Based on statistics from the US National Institutes of Mental Health, in 2014, about 7% of all adults in the nation had at least one major depressive episode in the past year, while more than 10% of the adult population is affected by mood disorders generally.

The World Health Organisation estimates that depression is the leading cause of disability for people in midlife and for women for all ages. The severity of the disease means that depression is not one to be ignored. As such, the usual prescription is anti-depressant medications. However, these medications are not without side effects.  

The efficacy of mindfulness as therapy  


Mindfulness has been found to help people with mental illness and post-traumatic stress. This is in fact the basis for Mindfulness-Based Cognitive Therapy (MBCT), an intervention that integrates cognitive methods with mindfulness.  

MBCT instructs the patient to become aware of and accepting towards incoming thoughts and emotions. It is believed that through mindfulness, patients can come to realise certain feelings which might be recurrences of negative thought patterns, and move on to respond to their negativity in a more suitable manner.   

The MBCT programme is a group intervention “treatment” that lasts eight weeks. A two-hour course is held weekly during this period of time. The patients are also supposed to engage in their own practice outside of the class, as they attempt to cultivate mindfulness in their daily lives through guided meditations by a trained therapist.  

The MBCT has been found to confer a 43% reduction in relative risk for relapse among participants as compared to controls. However, despite its efficacy, there are challenges to its dissemination and hence its viability as a way of therapy. For instance, the logistics of the scheduling and delivery of the two-hour course with groups of eight to 12 participants, as well as a shortage of trained therapists skilled in the delivery of the programme may reduce therapeutic results.

Mindful Mood Balance to address the inadequacy of MBCT

Having observed the ubiquity of the web and the rapid development of the smartphone and tablet technology, two clinical psychologists – Zindel Segal and Sona Dimidjian – became inspired to develop the Mindful Mood Balance (MMB).  

MMB, a web-based intervention, was designed to treat residual depressive symptoms and prevent relapse. It follows closely to the concepts of MBCT, with the only difference being that delivery is now over a web-based platform.  

Such a platform offers clear advantages, among which is increasing accessibility. Dimidijian had witnessed the difficulty in reaching out to pregnant women and young mothers – people who were too busy and at very high risk of developing depression.  

The web-based platform could also address the issue of trainer styles and methods. In the MBCT, the participants are guided by a trained therapist.  

However, just as in school, where the same material can be packaged and delivered differently by different teachers, the variance of trainer styles and their methods mean that there is very often no consistency in the delivery. There is also the possibility of the trainers injecting their own personal belief systems into the work, which can distort the content of the MBCT.  

Research has indicated that web-based psychological interventions are not only a cost-effective way to manage clinician resources, but also reduce service costs for the patient as they eliminate travel and waiting times. The MMB is clearly superior in these aspects.  

Nevertheless, as MMB is still in its infant stages of development, there is still some tweaking necessary for it to become a fully viable treatment for patients with depression or other sub-threshold symptoms of unipolar affective disorder. MIMS  

Read more:
Psychosomatic illnesses: ‘It’s all in the mind’ is not the answer
NHMS: Mental health patients in Malaysia have doubled over ten years
Most doctors with mental health issues do not seek treatment

Sources:
http://www.channelnewsasia.com/news/singapore/the-stigma-of-depression-those-who-suffer-in-silence-8044448 
https://www.mindful.org/mindfulness-future-therapy/  
https://www.ncbi.nlm.nih.gov/pubmed/21802618?dopt=Abstract  
http://www.jmir.org/2014/3/e87/