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Key points
- Due to a lack of mental health professionals, we have failed to deliver guideline based care, which recommends CBT before or alongside drugs.
- As a result, medication is the only treatment option available for the majority of people with mental health conditions.
- Ultimately, there should be two options to treat mental health: prescription drugs and behavioral interventions, including CBT.
- Digital therapeutics can offer expanded access to much-needed behavioral interventions to deliver guideline recommended care at-scale.
The COVID-19 pandemic is testing our threat response like never before.
While humans are normally good at problem-solving—our brains are designed to be attentive to threats so we can formulate a solution—none of us was prepared to deal with a crisis of this magnitude. And despite living with this threat for almost two years, the pandemic is an ever-changing danger that forces us to grapple with prolonged uncertainty.
Though vaccines have saved many lives and continue to do so, new variants stoke ongoing uncertainty. Many of our coping skills are breaking down in the face of such an unprecedented calamity. Rates of clinical mental health conditions have sharply risen in the U.S. during the pandemic, with around four in ten Americans reporting symptoms of anxiety or depressive disorder—an increase from one in ten U.S. adults before COVID-19.
As a mental health professional, I believe we have a duty to treat mental health issues according to guideline-recommended care. Unfortunately, a first-line recommended treatment—in-person therapy—is not available at scale. Simply, there are too few psychologists for those who need them and, for many, therapy is neither affordable nor readily accessible. In fact, some data suggests that 60 percent of people with mental health issues today are unable to receive treatment.
Prescription drugs, while widely available and effective in treating common mental health conditions such as depression, insomnia, and anxiety, are the only clinically-backed treatment option that is actually available for most people. However, for almost a generation, leading clinical guidelines, such as those from the National Institute for Health and Care Excellence (NICE) and the American College of Physicians (ACP), have told us behavioral interventions—non-drug treatments to modify behavior, emotional states, or feelings—should be at the forefront of care, alongside medications.
Yet we’ve been waiting indefinitely for universal access to guideline-recommended care. Imagine if we told people they had to wait months to put a cast on their broken arm, or that people had to wait a generation for COVID-19 vaccines. When the current lack of treatment options for mental health is compared to physical conditions, it's easy to recognize the inadequacy of our current approach.
Ultimately, I believe there should be two options to address a common mental health disorder: Prescription drugs and behavioral interventions, including cognitive-behavioral therapy (CBT). To date, we have failed to deliver guideline care, and because of the scarcity of mental health professionals, medications have been filling much of the gap.
This reality was recently detailed in the Drug and Therapeutics Bulletin showing alarming trends in antidepressant prescribing patterns. This includes inappropriate long-term use of these medications due to the lack of access to therapists and other behavioral interventions. As the report shares, medication misuse often leads to significant side effects like emotional numbness, fogginess, sexual dysfunction, and dizziness. Don’t get me wrong—I’m glad that we have these medications because they offer some treatment, but the problem to be solved is, in truth, a gap in psychological care provision.
This might be where digital therapeutics come in. They take proven behavioral approaches that are traditionally delivered by human therapists, including CBT, and fully automate them. CBT is a family of behavioral interventions that has been proven effective for a range of problems, including depression, anxiety, and sleep disorders. The ultimate goal is to reduce our upset emotions, such as anxiety, and focus on increasing positive behavioral health. In short, CBT helps give people tools to manage their mental health in the long term.
Like many other forms of therapy, leading digital therapeutics are evidence-based, rigorously tested, and have a low risk of side effects. In fact, in a randomized controlled clinical trial that I co-authored, a digital therapeutic for anxiety (named Daylight) helped 71 percent of people achieve clinical improvement. Just like doctors need pills to help their patients get better, psychologists need tools to expand access to behavioral interventions through CBT. Research like this suggests that this can now be possible through digital therapeutics.
Personally, I firmly believe digital therapeutics will become the new normal—and the future of mental health care—because they scale access to CBT. In keeping with recommended clinical care, both CBT and drugs should be immediately available to everyone and anyone who needs them. Digital therapeutics could help make that wish a reality.
COVID-19 has taught us that the virus needs a vaccine. However, the experience of COVID and its legacy, living with fear, uncertainty, and poor sleep may not be best addressed as a chemical challenge or imbalance. Drugs can’t teach people critical coping skills nor erase the root causes of the collective trauma we have all experienced due to the pandemic.
Digital therapeutics can make administering behavioral interventions like CBT easier, because there is no longer a supply and demand issue—like with in-person therapy—nor are there adverse reactions of concern. As a society, we have for a long time recognized that medicine is an essential service. The advent of COVID has helped society to see that mental health is just as important as physical health. If we want to lessen the impact of this current mental health crisis and protect generations to come, we can no longer view psychological care as a “nice-to-have.”
Mental health care is an integral part of our health. Digital therapeutics could help expand the opportunity for all people, regardless of socioeconomic status or race, to get access to therapy whenever they need it. As horrific as the pandemic has been, it’s granted people the opportunity to recognize and acknowledge how important mental health is. I argue that we should give our society the tools to address our ailing mental health—and the behavioral issues it has caused—starting with expanding access to digital therapeutics.
