Asynchronous digital therapy provides effective help
People who have mental disorders want to choose when to communicate digitally with the therapist. If we look at resource use and costs, this also works well for therapists. In this article, you will learn about the research of psychologist and researcher Tine Nordgreen, head of Centre for research-based innovation on Mobile Mental Health, at Haukeland University Hospital and the University of Bergen.
Many people have panic disorders, social anxiety and depression. Half of the population develops a mental disorder during their lifetime. The incidence of mental disorders has long been stable. It is said that everyone should have equal access to mental health services, but this is not the case. There is a lack of health professionals and capacity in both specialist and primary health services, which gives a long waiting time for people in a difficult situation.
Studies have shown that non-fatal diseases, such as mental disorders and musculoskeletal disorders, leads to high treatment costs and loss of participation in working life. These ailments cost society more than deadly diseases.
With the internet, people started chatting about their health online and looking for health advice, also when it came to mental health problems. There are many indications that people wanted digital therapy long before the health sector was able to provide it to them. Internet therapy is now available in almost all of Norway.
Studies on internet therapy, including one that dealt with treatment in Norway, Denmark, Sweden, Canada and Australia, have shown that users who receive online therapy are generally as satisfied as those who attend a physical session.
eCoping («eMeistring») at Helse Bergen started in 2013 with the first client. In previous years, the researchers had investigated the potential for online treatment in the specialist health service. Since then, a number of studies have been published that contribute to a more solid knowledge base.
«We found out early on that a therapist can have three times as many consultations online than by physical attendance. It is important, because the need for mental health care is great and the availability of help is limited,» says psychologist and researcher Tine Nordgreen at Haukeland University Hospital and the University of Bergen.
In 2019, the authorities decided that eCoping's internet treatment for mental disorders was approved for use in the health care service in Norway.
Benefits of asynchronous digital therapy
Guided internet treatment can take place in several ways. eCoping uses cognitive behavioral therapy and the treatment consists of 8-9 modules that run over 14 weeks. The patient and therapist have weekly contact via the messaging function and support calls via telephone, video or face-to-face when needed.
Asynchronous digital contact with patients has many benefits. For example, it is no longer a problem that a patient does not show up at the agreed time with the therapist. The person can sit at home, log on and write in their program.
There are three ways to get treatment for a person who wants help:
- Referral from a GP
- Referral from a community psychiatric centre
- The person contacts eCoping themselves
The person is then invited to a conversation with a psychologist. They talk about medical history, symptoms and other topics. This is done according to practice in the specialist health service. Then a diagnosis is given. If they find out that internet-based support will suit the person, the treatment is started.
«Inside the computer program, it looks different to the patient compared to what the therapist sees. Patients have worksheets, they plan exposure to what they are afraid of, write down and process thoughts. The therapist gets information about messages, notes, progression and much more,» says Nordgreen.
They ask patients to fill out a questionnaire to find out what they like or dislike about the online treatment, and what they may miss in contact with the therapist.
The working day of an internet therapist
«Who can become an e-therapist?»
«We have many different professionals: nurses, social workers, psychologists and doctors. In addition, we are open to volunteers being resources. Maybe people with user experience can consider becoming advisers? Several other low-threshold services use peer support workers, but we have not looked at this yet.»
«Who wants to receive e-therapy?»
«In the beginning, it was not possible for people to make direct contact with the service, they had to be referred via the GP. Many wondered if we would get a flood of inquiries when people themselves could contact us. But it did not happen. We may see some differences in levels of education, that more people with higher education make direct contact while people with lower education come to us via the GP. Research from the UK showed that people with a minority background more often sought digital therapy when they could approach the service directly,» says Nordgreen.
With asynchronous treatment online, there is a distance between therapist and patient. Not being able to "speak out" can be a challenge, not being able to use or read another person's body language, is another potential barrier.
«It is important that the therapists are well prepared when they write to the patients and that they write messages that communicate good knowledge of the individuals and what they struggle with. The messages should be personal, varied and motivating. The therapist must not interpret or assume, but always ask if they are unsure of the meaning. The words must also show empathy. In eCoping, guidelines have been made for good communication,» she says.
Sees and treats the whole person
Nordgreen is concerned with the prevention of ailments and seeing the whole person - not always dividing the treatment into different silos for mental and somatic health. She cites an example, women who have had gynecological cancer. Nordgreen has led the Gynea project, which is a new online program for this patient group.
«When women are discharged from the hospital after treatment, they get a final meeting. Then it takes a few weeks at home, before many feel the consequences of the body having changed, and perhaps also mentally. Uncertainty and fear of relapse are common concerns, but they need to be heard and supported so that they can cope. Prevention, treatment and rehabilitation – we can develop more online information and e-learning for patients across diagnoses.»
«Will all actors in the health service use digital therapy now?»
«I think it is more immature than we admit. We see that the effects are as good as with face-to-face treatment. The service is good and research-based. But: we are still struggling to find out what this means for the health actors. There are gaps in the health ecosystem and few staff positions at, for example, hospitals, which can administer new processes. The everyday lives of patients and caregivers have changed, but the organizations must follow up with functions and roles that can support the new. The municipalities will also benefit from using more digital care services,» she concludes.