A Quick Introduction to Digital Therapeutics for Mental Health Clinicians

Mental health care professionals who practice telehealth may find themselves wondering, “What other digital tools are available to support my patients?”

In an interview with Psych Congress Network at the 2024 Elevate meeting in Las Vegas, Nevada, Olusola Ajilore, MD, PhD, professor of psychiatry, University of Illinois, Chicago, believes that technology is not here to “replace us, but enhance what we do as clinicians.” In this Q&A, Dr Ajilore provides an overview of digital therapeutics, including AI chatbots and FDA-approved apps, that telehealth clinicians and their patients may find helpful to augment existing treatment plans. In addition, he details how clinicians can evaluate emerging digital therapeutics to determine if they’re effective and safe options for patients to interact with.

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Psych Congress Network: Could you give us a brief overview of the pros and cons of AI chatbots that operate as stand-in therapists?

Olusola Ajilore, MD, PhD: I think the big pro of AI chatbots is the convenience. They’re more easily accessible. They can be cheaper. There's also the potential for them to be customizable, so you could have it speak or interact with you in the way that you prefer or the way that you want. I think those are all some of the clear advantages of using AI chat bots.

Some of the cons, though, come in terms of things like privacy and confidentiality. We don't know if you're talking to an AI chat bot where that data is going—is it being preserved in a way that preserves your privacy? Or is it being shared with third-party vendors that can then use it to target advertising towards you or something like that? The other con is that the chatbot doesn't necessarily get the context of what you're dealing with as a patient or as a client. So, it might miss some of the things that you could only get through human to human interaction because of the way that you are interacting with the chatbot, either by texting or by talking. A lot of things can be missed in terms of body language, facial responses—all of that still has not been incorporated into AI chatbots in a way that allows it to get some of the context that's required to make an accurate clinical decision or to make a therapeutic alliance that you can only get currently with human therapists.

Psych Congress Network: How might those chatbots be integrated into clinician supervised treatment plans?

Dr Ajilore: I think the way that it can be integrated into clinical practice is that it can be very useful as a stopgap measure for people who have access issues with mental health care. You can imagine folks that have more mild to moderate symptoms for, let's say, depression or anxiety, this could be a very useful interim step to get them over the hump. If they feel like they still need additional treatment or additional resources, they can then go to see an actual therapist or an actual clinician. But there might be 20% to 25% of people on a therapy wait list, for example, that could get benefit from an AI chat bot that now no longer have to wait to get that treatment.

Psych Congress Network: Could you walk us through a couple of the FDA-approved digital therapeutics for mental health care?

Dr Ajilore: There are 2 that have recently come out. One is Endeavor RX from Akili Interactive, and it’s FDA-cleared for the treatment of pediatric attention-deficit/hyperactivity disorder (ADHD). It's a video game that involves various cognitive processes. It basically tasks your attention and your focus. The idea is that by playing this game, it improves things like, accuracy, reaction time, and cognitive performance. They've done a couple studies to demonstrate that.

Another one is Rejoyn from Otsuka, which was just FDA-cleared. It's an emotional face matching task that is designed to engage the dorsolateral prefrontal cortex, which is a brain region involved in emotion regulation and its connection to the amygdala, which is associated with emotional processing. The idea is that it enhances your emotion regulation capabilities by engaging these brain circuits, and it's currently approved as an adjunctive treatment for major depressive disorder. So it's not meant to be a standalone treatment, but it's meant to be used alongside, let's say, medication or other interventions.

Psych Congress Network: What practical guidance can you offer healthcare practitioners on reviewing and selecting appropriate digital therapeutic options for their patients?

Dr Ajilore: Fortunately, there are a lot of really good guidelines and frameworks available online to help clinicians sort of navigate the murky waters of digital therapeutics. The one that I recommend and I'll be talking about is App Advisor from the American Psychiatric Association. They have basically a set of criteria by which you can judge the quality of a digital therapeutic. For example, is the way that they're handling the data transparent? Is it usable? Is it accessible? Is it something that's only available on a smartphone or can you use it on a tablet or a computer? Is there a strong evidence base for its efficacy for the condition that you want to use it for? Right?

So, those are some of the best ways to critically evaluate some of the technology that's out there. Another even more simple thing you could do is you can ask your patients. There’s a lot of information out there that patients share with each other about what works for them. For example, I've had patients give me rave reviews of apps like Calm and Headspace, and they use it to great effect. So, ask your patients: what do you use? What do you recommend? You can also take the opportunity to try these things yourself, right? I've downloaded a lot of these apps like Calm, Headspace, some of the chatbots and tried them out myself and see if this is something that I feel is good enough to recommend to my patient or to my client.

Psych Congress Network: How do you envision the future role of AI chatbots and digital therapeutics in mental healthcare?

Dr Ajilore: I think the big one is the use of generative AI in AI chatbots, which is through OpenAI, the technology behind ChatGPT. A lot of the AI chatbots that are commercially available, like Youper or Wysa, they use a form of AI that's actually more restricted. It relies on scripted, canned responses where they have very complicated, sophisticated decision trees on how those responses are generated and how they're given back to the user. But it's still scripted and curated responses. The difference with generative AI is that you have no idea how the chatbot is going to respond, right? That has a lot of promise, but it also has a lot of potential issues. So, I think ways that we can harness the power of generative AI, but also have control on how those responses are generated, I think will be the way forward for creating AI chatbots that are more customizable, that are more useful, that are more adaptable and cheaper.

Psych Congress Network: Are there any common misconceptions on this topic that you'd like to clarify?

Dr Ajilore: I think one of the biggest misconceptions is that technology is going to be the end-all be -all solution. It's going be a panacea to our problems related to access and quality of care. I think it will go a long way in helping access and quality of mental health treatment, but it's not a replacement So, the we can think about how to use these tools by, but not forget the human part, right? Not forgetting the role that we have as clinicians and the care of our patients and not letting the technology replace us, but enhance what we do as clinicians.

Olusola Ajilore, MD, PhD, is the Center for Depression and Resilience Professor in the Department of Psychiatry at the University of Illinois-Chicago. He graduated magna cum laude from Harvard University with a degree in biology. Dr Ajilore did his MD/PhD degree at Stanford University where he studied the negative effects of stress hormones on the brain. His lab currently uses computational neuroimaging techniques and digital biomarkers to better track and treat neuropsychiatric disorders. Dr Ajilore is also serves as the Associate Head for Faculty Development, the director the Mood and Anxiety Disorders Program and as a member of the National Advisory Mental Health Council for NIMH.