Human + Digital = Healing For Depression?

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Digital health has had an outstanding funding quarter; Rock Health reported over 6 billion dollars in funding so far in 2021. As the pandemic has shifted a lot of care to virtual modalities, this growth is likely to continue. A lot of work goes into implementing digital health with considerations that clinician’s believe and have confidence that digital tools are fitting additions to a care plan, and that referrals are easily embedded into their workflows. The promise of digital tools points to a compelling user experience to help someone feel better using a modality they already use daily, their phones- what is the correct dose of human guidance to digital support?

Self-help CBT also has tremendous promise, and studies have shown it to be as effective as face-to-face CBT when delivered to protocol. The challenge in a primary care setting is providing a protocolized dose of human support to accompany the self-help CBT. How might we engage and activate patients to leverage self-paced learning? How can deployment be simplified so the tools can be administered and supported to deliver improved outcomes?

A new paper by Naoaki Kuroda and colleagues from the University of Tsukuba, Japan, published in the Journal of General Internal Medicine, sheds light on the components of self-help CBT and the associated human support necessary to deliver positive outcomes. The authors sought to decant the optimal self-help elements of CBT and match them to the optimal techniques offered via humans to improve results significantly.

They conducted a systematic review and identified twenty-one interventions and twenty-one associated practice elements in twenty Randomized-Control Trials (RCTs). CBT elements including cognitive restructuring, homework assignments, and behavioral activation appeared in successful interventions in over 80% of the RCTs.

Human support increased the likelihood of success in a linear fashion. Further analysis showed minimal support was only successful for the CBT elements related to social support activation, homework assignments, and interpersonal skills. When a higher dose of human help was offered, more CBT elements were successful. Complete list of the CBT elements are listed below.

Source: doi: 10.1007/s11606-020-06449-y.

The value of this paper lies in delineating the intensity of human support when contrasted with self-help CBT elements. In a busy primary care setting, supporting repeat visits to deliver CBT interventions is challenging and unlikely to be provided with fidelity. Yet, primary care doctors see many patients with depression and anxiety, so decanting optimal human dose to self-help elements helps craft better real-world application of self-guided CBT. This paper also provides context to study further the optimal protocol for human support to optimize self-care to be delivered more effectively in primary care settings.

Thanks for reading – Trina
(Opinions are my own)

Kuroda N, Burkey MD, Wissow LS. Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review. J Gen Intern Med. 2021 Apr;36(4):869-880. doi: 10.1007/s11606-020-06449-y. Epub 2021 Feb 9. PMID: 33564943.

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