Can a Mental Health App Replace Face-to-Face Therapy? No… BUT It IS Far Better than Nothing
The Christiansen Institute offers thought provoking weekly articles on the potential for disruptive technology to help public education meet the demands placed on it. This week’s e-issue of their newsletter included an article by Thomas Arnett describing the potential for newly developed apps that rely on Cognitive Behavioral Therapy (CBT) to provide psychological and psychiatric support to schools. Mr. Arnett provides an overview on the use of these new apps as follows:
Untreated mental illness silently plagues a large portion of the United States population. Roughly one in five adults in America suffer from some form of mental illness in a given year, and approximately 60 percent of those cases go untreated. These statistics are similar for teenagers; and educators report that depression, anxiety, and social phobias among youth seem to be on the rise.
Fortunately, a new menu of online mental health resources start to address these unmet needs; and some pioneering options have efficacy results comparable to face-to-face therapy. Programs such as MoodGYM, MyCompass, and Beating the Blues teach principles and techniques from cognitive behavioral therapy (CBT) to help people suffering from anxiety and depression. Other online solutions designed for teens, such as Bite Back and Base Education, teach students how to focus, reduce stress, handle difficult emotions, and improve social relationships.
Will online alternatives disrupt traditional face-to-face therapy in the not-too-distant future? To answer that question, consider how they measure up to the disruptive innovation litmus tests.
The “litmus test” poses six questions developed by Clayton Christiansen to determine if a new technology has the potential to be “disruptive”— that is if a new technology can result in a paradigmatic change in the way a business is operated or a service is provided:
1. Does it target nonconsumers or people who are over-served by an incumbent’s existing offering in a market?
2. Is the offering not as good as an incumbent’s existing offering as judged by historical measures of performance?
3. Is the innovation simpler to use, more convenient, or more affordable than the incumbent’s existing offering?
4. Does the offering have a technology enabler that can carry its value proposition around simplicity, convenience, or affordability upmarket and allow it to improve?
5. Is the technology paired with a business model innovation that allows it to be sustainable with its new value proposition?
6. Are existing providers motivated to ignore the new innovation and not threatened at the outset?
In assessing the potential for these CBT apps Mr. Arnett acknowledges that the apps fall short on the second question posed in the “litmus test”. They clearly and unarguably fall short when compared to face-to-face therapy:
Online alternatives to therapy fall short on many fronts when compared to visits with professional psychologists. Current online software cannot read and interpret patient’s verbal and nonverbal cues to diagnose mental illnesses with professional accuracy, nor can it identify patients’ needs, preferences, and life circumstances to develop custom-tailored advice. Software also cannot form relationships with patients to motivate them and hold them accountable.
But even with that clear and unequivocal deficiency, the on-line apps are clearly superior to nothing, which is what troubled teens are getting now. Moreover, with some degree of hybridization is might be possible to use apps to help the limited number of trained school personnel address mental health issues. Mr. Arnett concludes with this:
Although professional psychiatrists, psychologists, and counselors may scoff at the limitations and risks of online mental health support, online options will not threaten professionals’ livelihood any time soon. Online options may be effective for helping people with moderate and untreated anxiety, depression, and addiction, but they have a long way to go before they can match high-quality professional treatment for more debilitating conditions such as severe depression, bipolar disorder, and schizophrenia.
If online mental health solutions have the potential to disrupt the traditional model of mental health care, the unfolding of this disruption cannot come soon enough for K–12 education. School psychologists, nurses, and social workers are in short supply, and many students do not receive needed mental health treatment. Meanwhile, many teachers find themselves shouldering students’ mental health needs on their own. Unfortunately, when mental illnesses go untreated, students pay the price in lower academic achievement and overall well being.
As my colleagues Julia Freeland Fisher and Michael Horn have written, schools that aim to address student achievement challenges need to integrate across factors beyond academics that affect students’ ability to learn. Mental health is definitely one such factor, and convenient, low-cost, disruptive alternatives to traditional mental health care may prove critical for unlocking schools’ capacity to bring high-quality mental health care under their roofs.
I read Disrupting Class, Clayton Christensen and Michael Horn’s book, roughly ten years ago and was and still am convinced that their book was full of ideas with great potential for public education. They used the transistor radio as a metaphor to describe how technology might enhance education. Like the transistor radio, technology could deliver instruction (or in this case therapy) in a rapid, low fidelity but inexpensive fashion to a wider audience. The teachers’ (or in this case therapists’) role would change from being the deliverer of low fidelity content to being the “refiner” of the content: they could offer periodic assessments of whether the student was mastering the content— or in this case whether the content was having the intended impact on the student’s well being.
Skeptics abound when it comes to using technology in education, a skepticism driven, in part, by the fear that on-line education will ultimately replace teachers (or in this case therapists) completely. But teachers— like the therapists– should not feel threatened by technology, for just as “Online options may be effective for helping people with moderate and untreated anxiety, depression, and addiction” the online options for instruction can only be effective for helping students who are self-actualized and motivated learners. Just as on-line apps for mental health will never be able to “match high-quality professional treatment for more debilitating conditions such as severe depression, bipolar disorder, and schizophrenia”, on-line instruction will never be able to motivate a student to learn and never be able to fully understand the unique needs of each student. That is where the art of teaching comes into play… an art that is being lost as we increasingly teach-to-tests at the expense of addressing each student’s potential.