Should we use more Digital Therapy in Clinical Practice?

Abstract

The use of smartphones devices for mental health purposes is rapidly growing, but especially for unguided apps there is a definite lack of evidence. Current meta-analyses suggest moderate effects in the treatment of depressive symptoms, nicotine addiction and social anxiety symptoms; but smartphone treatments seem to have only limited efficacy in treating general anxiety, PTSD, or suicidality (Goreis et al., 2020; Linardon et al., 2019; Weisel et al., 2019). Results for prodromal and early course psychotic symptoms were highly heterogeneous (Camacho et al., 2019). Moreover, a high drop-out rate is reported for smart-phone therapies (e.g. Torous et al., 2020). The short answer to our initial question is: We do not know yet, but we should be positive and open minded towards digital technologies in psychological therapy, because they are a powerful instrument to treat over a larger distance, and employ new possibilities and techniques in the therapeutic process. We should have a closer look on efficacy, safety and acceptance (in patients and clinicians) of digital therapy solutions. Both, patients and clinicians face new challenges ranging from data protection issues to unfamiliar therapeutic settings. Clinicians should know the limits of digital therapy and authorities should invest in digitalization of psychotherapeutic interventions. From our perspective , three digital therapeutic settings will fundamentally influence the psychological therapy in future: (1) Internet-based therapy, (2) smartphone-based therapy and (3) Virtual Reality applications. A substantial part of the published studies in the field failed to report side effects, adverse events, and other safety problems-the latter being a problem in psychological therapies per se. Only few studies report these data for specific applications (e.g. Boettcher et al., 2014). Most studies focus solely on the efficacy of the treatment, therefore we illustrate some current reviews in the present editorial and new developments indicating efficacy and promising results of digital therapies. Internet-based therapy Meta-studies regarding Internet-based therapy show heterogeneous outcomes. Some reviews found that Internet-based interventions are effective in reducing the incidence of depression and decreasing anxiety symptoms in adolescents and adults (e.g. Etzelmueller et al., 2020; Reins et al., 2021). This is contradicted by other reviews, which found only small effects in preventing depression (e.g. Rigabert et al., 2020). However, a recent review showed that telehealth applications and Internet-based therapy are useful tools in treating social anxiety (Andersson et al., 2014), post-traumatic stress disorder (PTSD) (Kuhn & Owen, 2020), and first RCTs show promising results of Internet-based