Telehealth Chatbots Promising, but Need Further Research

As part of a telehealth video series from this year’s Psych Congress Elevate conference, Psych Congress Network Telehealth Section Editor, Steven Chan, MD, MBA, answers the following 'hot topic' question: What research exists that supports or challenges the use of mental health apps in clinical practice, and what research is still needed? Dr Chan discusses the data surrounding internet-based CBT (ICBT), the use of chatbots, and where he sees areas of growth.

To watch more from this telehealth video series where Dr Chan’s answers more pressing questions, follow the links below:

• Assess Features and Set Realistic Expectations When Choosing and Using Apps in Clinical Practice
• How to Evaluate and Integrate Apps Into Treatment With Dr Steven Chan

Steven Chan (@StevenChanMD, www.stevenchanMD.com) is an actively-practicing physician at Palo Alto VA Health, specializing in psychiatry, clinical informatics, and healthcare technology. Dr Chan performs clinical research in areas of telehealth and digital mental health, with applications in underserved and minority health. Dr. Chan is a sought-after national speaker whose ideas, thoughts, and research have been featured by Talks At Google, JAMA, Telemedicine and e-Health, Journal of Medical Internet Research (JMIR), Wired, PBS, and NPR Ideastream.

Hi everyone. My name is Steven Chan, and I am a member of the steering committee for Psych Congress. I'm here today to talk about apps and here is another question about apps.

What research exists that supports or challenges the use of mental health apps in clinical practice, and what research is still needed?

Apps have been around for a decade, but it's also been built on the foundation of computer-guided and internet-based sort of systems. We've seen terms like computer-guided cognitive behavioral therapy (CBT) and internet-based CBT (ICBT). They have a long, rich history of being very effective, and so we are seeing these being incorporated into mental health apps in the form of the touch screen mobile functionality.

I think that there's more research that's going to be needed specifically for chat-style functions.

We're seeing chatbots with different sophistication. There are chatbots that help with administrative scheduling and customer support style functions. We're seeing chatbots that just provide education. Then then there are chatbots that have multiple-choice answers, and then there are full-on chatbots that will actually analyze your text and it's more free text. That is a lot more complicated. I think that there's going to be a lot more research that's needed specifically for whether chatbots can be as good as a lot of the other therapy modalities we have.

But it's promising if you just think of chatbots as another way of delivering content through, say, like websites, or pamphlets, or brochures. These are really great opportunities for us to reach people through new modes.

[With chatbots like] Facebook Messenger, Google Home, Alexa (a conversational chat bot), etc. there's a lot of work that can be done here. I think that we also need to have a lot more research for having interventions for substance use disorders. We have some universities like the College of Applied Health Sciences (AHS) and the Comprehensive Health Enhancement Support System (CHESS) from the University of Wisconsin, Madison.

We've seen the paratherapeutics ones for opiate use disorder and substance use disorders. I would like to see some more in this area, but there are a lot of options out there.