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Behavioral Solutions Offer Technological Reach and a Human Touch
Therapy has been digitized and is now available to people through their favorite devices. Digital access is funded by health plans, health systems, and many care providers. Consumers can use these interactive therapeutic tools anywhere, anytime they choose. These digital products overcome care access barriers of cost and inconvenience and may feel less stigmatizing because use is private and confidential.
A critical question about digital health products is whether their use should be self-directed or guided by professionals or their support staff. Policy experts who are focused on behavioral healthcare's chronic care access problem want self-directed tools that scale well to meet population needs. However, the key question is whether outcomes are equivalent for both types of use.
Behavioral executives are rightly excited about these self-help tools because early outcomes are quite good. These tools are especially valuable for people on clinic waiting lists and for use during and after behavioral treatment. Use in medical settings is the next big step—primary care is best suited for prevention and early intervention, and primary care physicians (PCPs) now recognize the many ways behavior can impact health.
Research on Digital Outcomes
While the issue is not settled, research suggests personalized support improves clinical results with these tools. This support takes many forms: messages from non-professional, trained guides; motivational messages of support that are system-generated via text; notification of program utilization to “teammates” (approved family or friends); and telephonic coaching from behavioral clinicians to provide highly individualized support.
The first study cited above is noteworthy. It was a randomized clinical trial using trained guides for people seeking care for depression and/or anxiety. It found that guided use of digital tools optimized the probability “of joint remission of anxiety and depression for 91.7% of participants.” Guided results were always superior for anxiety care and proved better for depression except for 28.5% of the participants.
The subgroup with optimal results on their own needs further study. This might facilitate matching people to their best modality, self-directed or guided. However, this obscures the more significant lesson from this research. While some people get good results independently, even limited support (e.g., text messages) improves outcomes. People are remarkably responsive to a supportive milieu.
This should not be surprising. We are social beings. Psychotherapy is a social form of healing with unique characteristics. Digital tools attempt to remove the social context and present therapeutic techniques independently. However, these studies suggest that adding a bit of social support helps many people get clinical results comparable to in-person therapy at a fraction of the cost.
Why would we not take the primary lesson from this research and implement digital health tools in various settings accompanied by a supportive milieu? There is no better place to start than integrated care settings.
A 2-Pronged Technology Anchor for Integrated Care
Integrated care typically refers to clinician collaboration. However, the affordability, accessibility, and clinical value of digital tools will likely make them a standard part of integrated systems in the future. Digital tools provide clinical value to many users without guidance, but the evidence suggests people prefer encouragement and social support, and primary care is the perfect anchor for this support.
Primary care offices will need help from behavioral executives to make this operational. Our executives should co-develop protocols for digital tools with their primary care colleagues. Forming personal connections is the first step to placing an anchor in primary care for our field. Our clinicians and technology should be rooted there as we evolve from specialty to integrated care.
Digital tools are not our only tech solutions for integrated care. Our anchor there is more secure with another critical piece of technology. Measurement-based care (MBC) is our field’s underutilized gem for monitoring and enhancing clinical outcomes. Ideally, it should accompany today’s migration of therapists into primary care—the optimal solution combines human and technical expertise.
Therapists are more likely to succeed with supportive technologies like MBC and digital therapeutics adapted for the setting. Both technologies have strong validating research. They should be implemented together in integrated care settings, not as fragmented solutions, but as behavioral technologies that enhance the human touch of therapists.
MBC may function differently in primary care since it was initially created to support psychotherapy. While it can similarly aid primary care work, services there are often brief. MBC’s greater value may lie in identifying behavioral risks too often missed by PCPs. We are fortunate that MBC is a robust solution with several useful features. The way to best use this technology may vary across clinical settings.
The main point is that behavioral tech products should be considered in any setting focused on behavior. Digital therapeutics and MBC can both enhance outcomes, and we have multiple vendors providing each product today. As we move into mainstream healthcare, we should improve behavioral work wherever it occurs. Let us aspire to a model in which our clinicians and technology potentiate one another.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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