Phones can help our anxiety and not just add to it

Phones can help our anxiety and not just add to it
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There are many reasons to be anxious right now:  the impeachment scandal, the existential threat posed by climate change, the seemingly existential threat of not getting many followers on Twitter, or the big presentation at work next week. The reasons to be anxious right now seem infinite.  

Extreme anxiety is an all-too-familiar experience for many. Around 19 percent of American adults will experience an anxiety disorder over the course of a single year ̶ the kind of anxiety that makes it hard to function, hurts relationships, work, academic success, physical health, and even increases the risk of suicide. Anxiety disorders are ubiquitous and touch pretty much every family at some point.

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Despite their high prevalence and serious repercussions, it can be maddeningly difficult to get good quality mental health care. It isn’t that we don’t know what can help. Treating anxiety is actually one of the success stories of the mental health field; we have literally hundreds of studies that support certain types of therapies, and these therapies often lead to a more enduring recovery than medications. 

Yet, only 16 percent of those with a diagnosable anxiety disorder receive an adequate dose of treatment in any given year. People struggling with social anxiety disorder will often wait 15-20 years before receiving treatment.

There are many reasons why accessing good quality care is difficult. There continues to be a stigma against mental illness, and obtaining mental health care coverage remains a challenge for far too many people. But even if those issues were fixed, the system still wouldn’t work. 

One problem with our current system is we assume that the only way to treat mental illness is one-on-one with a mental health professional in a clinic. This is a great option for those who can access and afford such care, but it will never be enough to address the national burden of mental illness.

A second problem is that even when we can access a provider, there are no guarantees that the provider will be trained to provide treatments based on the best available research support. Of course, no one type of treatment will work for all types of problems or patients, and many factors influence decisions about care, but when we ignore the research, we miss the chance to learn from thousands of patients who have struggled with the same problem.

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We need to shift the paradigm. We need to figure out new ways to deliver high quality care so that more people can get the help they desperately need.

Technology can be our partner. Much is written about the dangers of technology and its addictive qualities, but technology-based delivery models via mobile phone or computer can also allow us to deliver services to people in the palm of their hand at any time of day or night for a fraction of what it would cost to treat each person in a clinic. Some of these approaches, using the Internet, deliver the same elements of well-established treatments, often showing comparable results to in-person care. There is extensive evidence that patients can reduce their anxiety and depression symptoms and improve their work and social adjustment with computer-based cognitive behavior therapy, and the potential reach of these programs is astounding. 

smoking cessation program offered via the web in English and Spanish has been delivered to more than 150 countries and nearly 300,000 people. Other approaches offer new interventions that are purposefully designed for technology delivery, such as “cognitive bias modification,” that are still undergoing testing but show some promising results. The  MindTrails Project offers free interventions to change anxious thinking. 

This is not a diatribe against one-on-one treatment in a mental health professional’s office. Individual therapy is a terrific option for those who can access it. I’m a licensed therapist who trains graduate students to be therapists. It’s just not enough to meet the needs. 

Addressing the lack of accessible, high quality mental health care requires big solutions; fortunately, we have innovative delivery models available. “Task shifting,” where we train non-specialist providers, such as peers or community members, to deliver key elements of therapies that tend to be effective can achieve amazing gains.

Suddenly, instead of only a few providers in a remote region, there can be a trained provider in every classroom or neighborhood. These non-professionals likely won’t be able to offer specialized services or work with the most serious or complex cases, but they can treat common problems like anxiety and depression where we know a lot about the specific aspects of treatment that can help. Evidence from dozens of countries around the world has shown this model can work. 

In addition, we need to bring treatment to people directly. People want help when and where they need it most; they certainly don’t want to spend months on a waitlist or travel long distances to see a provider. So, let’s bring treatment to people instead of waiting for them to come to us.

For instance, lay counselors successfully delivered therapy to Burmese survivors of imprisonment and trauma in their homes and local community settings in Thailand. There are now many exciting examples of delivering medical health care services in the spaces where people already frequent – hair salons, pharmacies, and schools — this can work for mental health care too.

Regardless of what mental health care delivery model someone uses, they need to ask whether the approach is based on sound research. There are literally hundreds of different therapies and thousands of mental health apps available that have not been well tested in research, so finding the right treatment can be confusing. Clinical practice guidelines provide information on which in-person therapies have strong research support, and PsyberGuide explains which mental health apps are based on research.

There are treatments that can help and no one should have to wait years to access good quality care. We would never accept that in our medical health care system, and we shouldn’t accept that in our mental health care system.  

Bethany Teachman, Ph.D., is a professor of psychology and director of clinical training at the University of Virginia, and a Public Voices Fellow with the OpEd Project. She is chair of the Coalition for the Advancement and Application of Psychological Science and recipient of a 2019 American Psychological Association Presidential Citation.