The Growing Trend of Digital Therapeutics in Health Systems and How It Can Help Address Mental Health Care Barriers

Alison Darcy, PhD, founder & president, Woebot Health, discusses how the pandemic helped restart the conversation surrounding the need to reform mental health care, and identifies the role digital therapeutics are playing in circumventing the traditional barriers to mental health care.  

Can you talk a little about how the current pandemic has restarted the conversation around needing to reform mental health care in America?

At the start of the pandemic, the focus of the mental health care conversation shifted away from convenience and toward safety, and then by default, when many had no choice but to utilize digital care options and adoption of them swelled, it became clear that outcomes weren't necessarily any worse when patients utilized digital versions of traditionally in-person services. This has pushed people's thinking in substantial ways, making the efficacy and validity of digital therapeutics nearly self-evident, and making digital therapy a real option for many who wouldn’t have otherwise considered it. We’ve been talking about flattening the curve in the pandemic, but we’ve been trying to do that in mental health for a long time, and these tools help with that.

Digital therapeutics are a growing trend in health systems. Can you tell us the role digital therapeutics are playing in circumventing the traditional barriers to mental health care?

There are many barriers that affect access to mental health care. The first is personal: many people who need help won’t get it because of the stigma they feel around asking for help. For others, therapy is too expensive, or even if they can afford it, there aren’t enough therapists to meet the surging demand. Those barriers are only getting higher and wider in the pandemic era. If we were to consider the only treatment option to be in-person therapy, we would have impossibly long wait lists. Digital therapeutics simply allow more people to access care, and access it in different, complimentary ways. 

I said earlier our mission is to make mental health radically accessible. That means accessible in every sense of the word: being able to get support, no matter the hour, and whether you have a diagnosis, or a prescription, or not; being approachable, destigmatizing, inclusive, and empathic, or emotionally accessible. It means treatment that adapts to every growth stage across a lifetime, because we all go through ups and downs. I think that the gold standard of care is being able to provide the easiest, lowest intensity, least invasive form of efficacious treatment possible, and if that doesn't work, then have a mechanism to quickly graduate people to a higher level of care. So clearly there is a role for both digital and traditional therapy; the trick is in reserving the precious human therapists for the people who really need to see them, and intervening earlier in the course of illness with lighter touch, less invasive tools like Woebot.  

Tell us a little about Woebot. How has it helped address mental health care gaps—especially during the pandemic?

When the pandemic broke out, Woebot delivered the first fully built-out, specially-crafted coronavirus content. Called “Perspectives,” it aims to inspire hope and encourage people to stay grounded, and to help them navigate grief, stress and sadness. We also surveyed our users to learn about the nature of their anxiety and depression symptoms during the pandemic. The data showed that at the start of the surge, those who were most affected by the pandemic, including essential workers and older populations, were faring better than others, while people 25 and younger reported more sadness and anxiety than any age group. In a subset of diverse users that were tracked following the surge, symptoms of depression and anxiety decreased over time. This spells positive news for both underserved patients and the digital health industry, which has rushed to serve various needs by providing everything from telehealth to digital solutions that can address symptoms stemming from depression, anxiety and substance use disorder.  

How can technologies such as Woebot help address mental health in some populations that are in more rural areas, or others that may traditionally have less access to care?

According to a Harvard Business Review article, nearly 40% of the United States live in areas designated by the federal government as having a shortage of mental health professionals. Over 60% of United States counties don’t have a psychiatrist within its borders. And some groups, including Black American adults, as the National Institute of Mental Health reports, experience serious psychological distress at higher rates than other groups but are less likely to be able to access the treatment they need. We built Woebot to fill this gap. One partnership we’re really proud of is that with the District of Columbia Housing Authority (DCHA). DCHA offers quality affordable housing to low- through moderate-income households. But they’re not just about housing. The agency is also focused on cultivating opportunities for residents to improve their lives, and is offering Woebot to its employees and residents. We’re really happy we can offer a solution that can help people deal with stress and anxiety in an accessible, approachable and anonymous way. 

What goes into a successful digital therapeutic, and why does it need to be both clinically effective and engaging?

Obviously, for a digital therapeutic to be medicinal, it must be clinically effective. But a lot of research suggests that clinical efficacy demonstrated in RCTs is not enough. Digital solutions must also be engaging in the real world. If you consider depression, the nature of the problem is one of disconnection, disengagement from oneself, one’s life and the world. This is why engagement itself can be considered an active ingredient, for to engage someone in a healthy practice, no matter how small, becomes very significant in this context. We think about engagement in a very deep sense. It’s not about yielding to persuasive digital parlour tricks that hack your dopaminergic response with bells and whistles; it’s about meaningfully engaging in the real work of psychotherapy, and that is not easy. That’s why we don’t use persuasive techniques in our app, we don’t try and keep people talking to Woebot as long as possible. Rather we optimize the app to empower people to use the tools in the moment they need them, and toward feeling better through real resolution. That is what is immensely rewarding over time.  

Is there anything else you would like to add?

The silver lining of the pandemic is that mental health has become so much more acceptable to talk about. Simultaneously, digital therapeutics continue to grow in legitimacy as people around the world deal with problems created by the pandemic, including economic hardship, loss of family members and fear of contracting the virus. I am hopeful that in our post-pandemic life, this combination of a new level of openness about our mental health and the availability of digital tools that can help people improve it will mean people look after their mental health as much as they do their physical health through exercise, to keep us all happier and healthier.  

About Dr Darcy

Alison Darcy, PhD, is the Founder and President of Woebot Health, a company dedicated to making mental health radically accessible. She has been exploring how digital solutions can help solve the problem of access to mental health care for about 20 years and started by creating an online support group for people with eating disorders. From there she decided to pursue a PhD in psychology at University College Dublin and post-doctoral training at Stanford School of Medicine. At Stanford, Dr Darcy met the visionary artificial intelligence (AI) expert Dr. Andrew Ng, and together they explored the intersection of AI and health care while she led his Health Innovation Lab in Computer Science. Dr Darcy left Stanford a few years ago to develop Woebot, an AI-powered conversational agent and app that delivers cognitive behavioral therapy (CBT) to people with anxiety and depression.