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WSJ’s look at digital therapy covers a lot of ground–except potential downsides

Rating

4 Star

To Treat Depression, Try a Digital Therapist

Our Review Summary

This story heralds the evolution of internet-based therapies for treating mild to moderate depression.  It summarizes several recent studies, which find that a combination of interacting with both a “smart” internet app and human therapists competes well with more traditional, face-to-face strategies.

The story hits a lot of the right notes, employing independent sources, making clear that efficacy studies are still relatively sparse, and giving readers access to actual study texts.  Missing from the story is any mention of potential downsides of internet-based therapies, an omission that seems important given the traditional, highly interpersonal nature of cognitive behavioral therapy.

 

Why This Matters

Initial research suggests that internet-based approaches to therapy can work for individuals with minor or moderate mental health problems.  If that good news continues to hold over the course of further studies, such a strategy would be a boon in areas of the world with few mental health resources.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

We’re rating this one a cautious “Satisfactory.”  The story offers no information about the cost to a patient of a digital therapist, but it does reflect on the cost of creating and maintaining a similar app.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This story does a good job of summarizing the benefits that accrued in the course of several studies.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Risks are not broached here. This is an issue for a topic such as this, as one could imagine readers expressing concern about the efficacy of a non-human “therapist.” The story actually acknowledges that concern in its second paragraph (“It [the use of technology] might seem surprising, since therapy, more than many other kinds of medicine, is so focused on the relationship between patient and therapist.” But it never digs into the possible debits of wrestling with moderate depression online. We also think the story should have discussed the risk patients being victimized in an open source or relatively open chat room or other online group setting. One important element of psychiatry is privacy and patient confidentiality.

Does the story seem to grasp the quality of the evidence?

Satisfactory

Three studies are summarized in this text and, although those summaries are brief, the story allows readers to link to the texts themselves for more details.  At least one of those studies, a meta-analysis, gathered the small number of experiments (13) that made explicit comparisons between internet-delivered and face-to-face cognitive behavior therapy.

Does the story commit disease-mongering?

Satisfactory

The text makes it clear that internet-based therapies may be more valuable for individuals with mild to moderate depression than for persons with severe depression, who would be more likely to seek face-to-face therapy regimens.

But, in a word of caution, does that encourage people to overdiagnose themselves? That’s something to consider.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Another cautious “Satisfactory.” One source is clearly identified as someone independent of one of the studies cited.  Two others experts are not so identified but are not listed as coauthors on any of the studies.  Funding for those studies is not mentioned.

It’s worth noting here that two of the sources seem to be heads of institutes that are involved in the development of technological/Internet-based treatment approaches; both could benefit financially from being able to treat many more patients online.

 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The piece discusses several interventions, and offers a graphic representation of recovery rates for individuals in Great Britain across five therapeutic modalities. But, there is no mention of psychiatric medications. Since those are frequently helpful in short-term situations and at least for moderate depression, they should have been included in the comparisons.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story identifies several therapeutic apps and, in a video, shows one individual using a “mobile therapy platform” to text and videochat with a therapist.  Several comments in the story about the continuing evolution of these applications suggest that these strategies remain works in progress.

Does the story establish the true novelty of the approach?

Satisfactory

A bit of historical information in the story makes it clear that online therapeutic agents have been around—in various stages of development—for more than a decade.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This story integrates studies and sources, making reliance on news releases unlikely.

Total Score: 8 of 10 Satisfactory

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