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E-raamat: Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future

Edited by (Tenure-track assistant professor, departments of Biomedical Data Science and Psychiatry within the Center for Technology and Behavioral Health in the Geisel School of Medicine, Dartmouth College, USA), Edited by , Edited by (Director of the Dartmouth Center )
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  • Ilmumisaeg: 27-Sep-2022
  • Kirjastus: Academic Press Inc
  • Keel: eng
  • ISBN-13: 9780323885614
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  • Formaat: EPUB+DRM
  • Ilmumisaeg: 27-Sep-2022
  • Kirjastus: Academic Press Inc
  • Keel: eng
  • ISBN-13: 9780323885614

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Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future presents the foundations of digital therapeutics with a broad audience in mind, ranging from bioengineers and computer scientists to those in psychology, psychiatry and social work. Sections cover cutting-edge advancements in the field, offering advice on how to successfully implement digital therapeutics. Readers will find sections on evidence for direct-to-consumer standalone digital therapeutics, the efficacy of integrating digital treatments within traditional healthcare settings, and recent innovations currently transforming the field of digital therapeutics towards experiences which are more personalized, adaptable and engaging.

This book gives a view on current limitations of the technology, ideas for problem-solving the challenges of designing this technology, and a perspective on future research directions. For all readers, the content on cultural, legal and ethical dimensions of digital mental health will be useful.

  • Gives a comprehensive overview of the field of digital therapeutics and research on their efficacy, effectiveness, scalability and cost-effectiveness
  • Introduces novel directions in which digital therapeutics are currently being extended, including personalized interventions delivered in real-time
  • Reviews important considerations surrounding digital therapeutics, including how they can be monetized and scaled, ethical issues, cultural adaptations, privacy and security concerns, and potential pitfalls
Contributors xi
Foreword xiii
1 Introduction: A vision for the field of digital therapeutics
1(4)
Nicholas C. Jacobson
Tobias Kowatsch
Lisa A. Marsch
1.1 Why read this book?
1(1)
1.2 Who is this book for?
1(1)
1.3 What topics are covered in this book?
1(2)
1.3.1 First section: Introduction to digital therapeutics
2(1)
1.3.2 Second section: The new frontier
2(1)
1.3.3 Third section: Structural considerations
3(1)
1.4 What will readers learn?
3(2)
2 Using digital therapeutics to target gaps and failures in traditional mental health and addiction treatments
5(14)
Nicholas C. Jacobson
Rachel E. Quist
Camilla M. Lee
Lisa A. Marsch
2.1 Prevalence and impact of mental health and substance use disorders
5(1)
2.2 Lack of treatment receipt in the traditional care system
5(2)
2.3 Barriers to traditional treatment: stigma, personal beliefs, and cultural competence
7(1)
2.4 Barriers to traditional treatment: cultural competence
7(1)
2.5 Barriers to traditional treatment: high cost and lack of insurance coverage
7(1)
2.6 Barriers to traditional treatment: transportation and appointment time availability
8(1)
2.7 Barriers to traditional treatment: inadequate number of mental health providers
8(2)
2.8 Barriers to traditional treatment: patient narratives
10(1)
2.9 Leveraging digital therapeutics to transform treatment models for mental health and substance use disorders
10(2)
2.10 A time of opportunity to transform models of mental health and substance use care via digital therapeutics
12(7)
References
13(6)
3 First wave of scalable digital therapeutics: Internet-based programs for direct-to-consumer standalone care for mental health and addiction
19(12)
Aimee N.C. Campbell
Christina A. Brezing
Matisyahu Shulman
3.1 Development of internet-based programs
19(2)
3.1.1 Internet-based programs versus mobile applications
20(1)
3.2 Internet-based programs for substance use disorders
21(2)
3.2.1 Therapeutic education system
21(1)
3.2.2 The CHESS-ACHESS program
22(1)
3.2.3 CBT4CBT
22(1)
3.2.4 Dual diagnosis patients
22(1)
3.2.5 Prevention and screening
22(1)
3.3 Internet-based programs for mental health (nonsubstance related disorders)
23(2)
3.3.1 Mood and anxiety disorders
23(2)
3.4 Summary and next steps for internet-based programs for substance use and mental health disorders
25(6)
References
26(5)
4 Second wave of scalable digital therapeutics: Mental health and addiction treatment apps for direct-to-consumer standalone care
31(14)
Patricia A. Arean
Ryan Allred
4.1 Overview of second-wave digital therapeutics
31(1)
4.2 Evidence base for second wave digital therapeutics
31(6)
4.2.1 Evidence base for mood tracking apps
35(1)
4.2.2 Evidence base for online peer communities
36(1)
4.2.3 Evidence base for serious games
36(1)
4.3 Cautions and limitations with second-generation digital therapeutics
37(1)
4.4 How to find effective second-wave digital therapeutics
38(1)
4.5 How to use second-wave digital therapeutics in practice
38(1)
4.6 Summary and future directions
39(6)
References
40(5)
5 Blending digital therapeutics within the healthcare system
45(20)
Olivia Clare Keller
Alan Jeffrey Budney
Cara Ann Struble
Cisbert Wilhelm Teepe
5.1 Introduction
45(1)
5.2 Blended care terminology
46(2)
5.2.1 Internet-delivered treatments
46(1)
5.2.2 Blended care
47(1)
5.3 Components and structure of blended care
48(1)
5.3.1 Therapeutic support
48(1)
5.3.2 Digital components
48(1)
5.3.3 Structure of blended care
48(1)
5.4 Blended care treatment approaches
49(1)
5.5 Development and value of blended care
50(2)
5.5.1 Development of blended care treatments
50(1)
5.5.2 Value of blended care
51(1)
5.6 Illustrations
52(5)
5.6.1 Examples of blended care interventions for MHD adapted for the use in the healthcare system
52(3)
5.6.2 Examples of BC interventions for SUD adapted for use in the healthcare system
55(2)
5.7 Challenges to the adoption of blended care
57(1)
5.8 Future directions and conclusions
58(7)
References
59(6)
6 Receptivity to mobile health interventions
65(12)
Roman Keller
Florian V. Wangenheim
Jacqueline Mair
Tobias Kowatsch
6.1 Introduction
65(1)
6.2 The anatomy of an "ideal" mobile health intervention
66(1)
6.3 Key processes of receptivity: receiving, processing, and using support
67(2)
6.4 What do we already know about states of receptivity?
69(3)
6.5 Challenges and future work
72(5)
References
73(4)
7 Adapting just-in-time interventions to vulnerability and receptivity: Conceptual and methodological considerations
77(10)
Inbal Nabum-Shani
David W. Wefier
Susan A. Murphy
7.1 Introduction
77(1)
7.2 Just-in-time adaptive interventions
78(1)
7.3 JITAI components
78(1)
7.4 States of vulnerability and receptivity
79(1)
7.5 Scientific questions about vulnerability and receptivity in just-in-time intervention development
80(1)
7.6 Analyzing observational ILD to inform JITAI development
80(3)
7.7 Analyzing ILD from microrandomized trials
83(2)
7.8 Conclusion
85(2)
Acknowledgments
85(1)
References
85(2)
8 A digital therapeutic alliance in digital mental health
87(12)
Benjamin Kaveladze
Stephen M. Schueller
8.1 Introduction
87(1)
8.2 What is therapeutic alliance?
87(1)
8.3 Applying therapeutic alliance to DMHIs: digital therapeutic alliance
88(1)
8.4 Defining digital therapeutic alliance
88(1)
8.5 Differences in DTA across interventions
89(1)
8.6 DTA in supported interventions
90(1)
8.7 DTA in unsupported interventions
90(2)
8.8 Measurement
92(1)
8.9 Impact
92(1)
8.10 Improving DTA
93(1)
8.11 The future of DTA
93(1)
8.12 Future directions and recommendations
94(1)
8.13 Conclusions
95(4)
References
95(4)
9 Conversational agents on smartphones and the web
99(14)
Timothy Bickmore
Teresa O'Leary
9.1 Introduction
99(2)
9.1.1 Definitions
99(1)
9.1.2 Advantages of conversational agents
99(1)
9.1.3 Disadvantages of conversational agents
100(1)
9.1.4 Systematic reviews
101(1)
9.2 Conversational agents on the web
101(3)
9.2.1 Barriers to use for web-based CAs
101(1)
9.2.2 Text-based CA interventions on the web
102(1)
9.2.3 ECA-based interventions on the web
103(1)
9.3 Conversational agents on smartphones
104(3)
9.3.1 Text-based CA interventions on smartphones
107(1)
9.3.2 ECA-based interventions on smartphones
107(1)
9.4 Safety issues in using conversational agents
107(1)
9.5 Future directions
108(1)
9.6 Conclusion
109(4)
References
109(4)
10 Voice-based conversational agents for sensing and support: Examples from academia and industry
113(22)
Caterina Berube
Elgar Fleisch
10.1 Introduction
113(3)
10.1.1 VCAs to relieve the healthcare system
113(1)
10.1.2 The advantages of voice modality
114(1)
10.1.3 VCAs to provide engaging digital health interventions
115(1)
10.2 Method
116(1)
10.2.1 Included and excluded cases
116(1)
10.2.2 Technical implementation
116(1)
10.2.3 Sensing and support
116(1)
10.2.4 Explorative approach
117(1)
10.3 Findings
117(8)
10.3.1 Simple active sensing prototypes
119(1)
10.3.2 Simple passive sensing research
120(1)
10.3.3 Simple passive sensing products
121(1)
10.3.4 Simple reactive health support research
122(1)
10.3.5 Simple reactive health support products
123(1)
10.3.6 Multidimensional health prototypes and products
124(1)
10.4 Most prevalent features and trends
125(2)
10.4.1 Primary findings
125(1)
10.4.2 Reactive support is easier to implement
125(1)
10.4.3 Active sensing requires costly regulations compliance and good speech recognition
125(1)
10.4.4 Passive sensing requires extensive and rigorous data collection
126(1)
10.4.5 Concerns around data and conversation privacy
126(1)
10.4.6 Amazon Alexa seems to rule the market
127(1)
10.5 Conclusion and outlook
127(8)
References
128(7)
11 Design considerations for preparation, optimization, and evaluation of digital therapeutics
135(16)
Shawna N. Smith
Nicholas J. Seewald
Predrag Klasnja
11.1 Introduction
135(1)
11.1.1 Overview of chapter
135(1)
11.2 A framework for designing and evaluating digital therapeutic interventions
136(2)
11.2.1 What do we mean by design?
136(1)
11.2.2 The importance of optimization for digital therapeutic design
136(1)
11.2.3 A conceptual framework for informing design decisions
137(1)
11.3 Design considerations for intervention development
138(5)
11.3.1 Phase 1: formative work
138(1)
11.3.2 Phase 2: optimizing intervention design and deployment
139(4)
11.4 Design considerations for short-term & long-term efficacy, effectiveness, and implementation
143(3)
11.5 Discussion and conclusion
146(5)
References
147(4)
12 Cultural adaptations of digital therapeutics
151(14)
John A. Naslund
Jessica Spagnolo
12.1 Introduction
151(1)
12.2 Global burden of mental illness and need for cultural adaptation
152(1)
12.3 Methods of cultural adaptation
153(2)
12.4 Cultural adaptation of digital interventions
155(3)
12.5 Recommendations for applying cultural adaptations to digital therapeutics
158(2)
12.6 Conclusion
160(5)
Acknowledgments
160(1)
Declaration of Interest
160(1)
References
160(5)
13 Building the digital therapeutic industry: Regulation, evaluation, and implementation
165(12)
Megan Coder
13.1 A new category of medicine
165(1)
13.2 Digital Therapeutics Alliance
165(1)
13.3 Industry progression
165(1)
13.4 2017-2021: Foundation building
166(6)
13.4.1 Landscape mapping
166(1)
13.4.2 Digital therapeutic definition
167(1)
13.4.3 DTx core principles & best practices
167(1)
13.4.4 Intended use & mechanism of action
168(1)
13.4.5 DTx product categorization
168(1)
13.4.6 Regulatory frameworks
168(3)
13.4.7 Industry's expanding value
171(1)
13.5 2022 & beyond: Equipping decision-makers and end-users
172(3)
13.5.1 Harmonized evaluation frameworks
173(1)
13.5.2 Global recognition & utilization
173(1)
13.5.3 National policy development
173(1)
13.5.4 Clinical guideline & practice inclusion
174(1)
13.5.5 Personalized therapies
174(1)
13.6 Looking ahead
175(2)
References
175(2)
14 Potential pitfalls and lessons learned
177(12)
Frances Kay-Lambkin
Milena Heinsch
Dara Sampson
14.1 If you build it, we will come, but we may not stay
178(1)
14.2 The human element
179(1)
14.3 Access does not equal uptake
180(2)
14.4 A "lift-and-shift" approach does not work
182(1)
14.5 A blended model of treatment is needed
183(1)
14.6 Multidimensional, theory-informed implementation models are needed
183(2)
14.7 A more responsive research and development cycle is needed
185(1)
14.8 Summary
185(4)
References
185(4)
15 Privacy and security in digital therapeutics
189(16)
Leysan Nurgalieva
Gavin Doherty
15.1 Introduction
189(1)
15.2 Background on privacy and security in digital therapeutics
189(4)
15.2.1 Digital health ecosystem
189(1)
15.2.2 Security and privacy risks in digital mental health
190(3)
15.3 Relevant security and privacy regulations
193(2)
15.3.1 United States regulations
193(1)
15.3.2 European regulations
194(1)
15.3.3 Other regulations
194(1)
15.4 Addressing privacy and security concerns
195(3)
15.4.1 Privacy and/or security evaluation frameworks and tools
195(1)
15.4.2 Security and/or privacy evaluation techniques
195(1)
15.4.3 Security and/or privacy design practices
196(1)
15.4.4 Usability and interaction design
197(1)
15.5 Conclusions
198(7)
References
198(7)
16 Ethical considerations of digital therapeutics for mental health
205(12)
Constantin Landers
Blanche Wies
Matteo Ienca
16.1 Introduction
205(1)
16.1.1 Setting the context
205(1)
16.1.2 What this chapter does and does not
205(1)
16.2 Ethical issues arising from digital therapeutics in mental health
206(8)
16.2.1 Issues directly affecting patients using digital therapeutics
206(4)
16.2.2 Societal concerns arising from digital therapeutics
210(3)
16.2.3 Health care professionals
213(1)
16.3 Conclusion
214(1)
16.4 Appendix
214(3)
Bibliography
214(3)
17 A look forward to digital therapeutics in 2040 and how clinicians and institutions get there
217(36)
Donald M. Hilty
Christy M. Armstrong
Amanda Edwards-Stewart
David D. Luxton
17.1 Introduction
217(1)
17.2 Technology's role in shifting care: market pull from users and the push from artificial intelligence
218(7)
17.2.1 People empowered by mobile technologies
218(1)
17.2.2 The research and planning enabling the shift
218(7)
17.3 A look at how users' experience of care and clinical workflow will change by 2040
225(2)
17.3.1 Overview
225(1)
17.3.2 Evolution of the healthcare team
225(1)
17.3.3 Interprofessional teamwork
226(1)
17.3.4 Technology and active learning
226(1)
17.3.5 Workflow practices on the rise
227(1)
17.4 Using technology for integrating care
227(13)
17.4.1 Technology training (competencies) and evaluation
228(12)
17.4.2 Digital and cultural literacy
240(1)
17.5 System and institutional shifts for 2030-2040
240(3)
17.5.1 Overview
240(1)
17.5.2 Human factors
240(2)
17.5.3 Financing, reimbursement, and licensing
242(1)
17.5.4 Institutional competencies
243(1)
17.6 Discussion
243(2)
17.7 Conclusions
245(8)
Acknowledgments
246(1)
Conflicts of Interest
246(1)
References
246(7)
Index 253
Nick Jacobson is a tenure-track assistant professor in the departments of Biomedical Data Science and Psychiatry within the Center for Technology and Behavioral Health in the Geisel School of Medicine at Dartmouth College. He directs the AI and Mental Health: Innovation in Technology Guided Healthcare (AIM HIGH) Laboratory.

Dr. Jacobson researches the use of technology to enhance both the assessment and treatment of anxiety and depression. His work has focused on (1) enhancing precision assessment of anxiety and depression using intensive longitudinal data, (2) conducting multimethod assessment utilizing passive sensor data from smartphones and wearable devices, and (3) providing scalable, personalized technology-based treatments utilizing smartphones. He has a strong interest in creating personalized just-in-time adaptive interventions and the quantitative tools that make this work possible. To date, Dr. Jacobsons smartphone applications which assess and treat anxiety and depression have been downloaded and installed by more than 50,000 people in over 100 countries. Dr. Tobias Kowatsch is Assistant Professor for Digital Health at the University of St. Gallen and the Scientific Director of the Center for Digital Health Interventions, a joint initiative of the Department of Management, Technology and Economics at ETH Zurich and the Institute of Technology Management at the University of St. Gallen. In close collaboration with his interdisciplinary team and research partners, Tobias designs digital health interventions ("digital pills") at the intersection of information systems reserach, comuter science and behavioral medicine. He helped initiate and participates in the on-going development of MobileCoach, an open source platform for ecological momentary assessments, health monitoring and digital health interventions. He is also co-founder of the ETH Zurich and University of St. Gallen spin-off company Pathmate Technologies that creates and delivers digital clinical pathways. Dr. Lisa A. Marsch is the Director of the Dartmouth Center for Technology and Behavioral Health, a designated Center of Excellence” supported by the National Institute on Drug Abuse at the National Institutes of Health. She is also the Director of the Northeast Node of the National Drug Abuse Clinical Trials Network based out of Dartmouth and the Andrew G. Wallace Professor within the Department of Psychiatry at the Geisel School of Medicine at Dartmouth College. And, she leads a national Science of Behavior Change” initiative supported by the National Institutes of Health with partners at Dartmouth, Stanford, Arizona State University, Drexel, and MIT. In addition to directing this national Center, Dr. Marsch has personally been Principal Investigator on 35 grants, largely from the National Institutes of Health. She has led the development, evaluation and implementation of technology-based therapeutic tools for addiction treatment, HIV prevention, mental health, chronic pain management, substance abuse prevention, smoking cessation, and binge eating disorder. Her work in technology and addiction treatment has been particularly pioneering, as she is widely recognized as having led the development of one of the most widely tested and evidence-based mobile intervention for addiction treatment. Dr. Marsch publishes extensively and is a regular keynote speaker at national and international scientific meetings (including invited presentations at the White House, Congressional briefings, the World Bank, and for the US Surgeon General). She has served as a consultant to the Department of Mental Health and Substance Abuse at the World Health Organization. She serves on the National Advisory Council to the National Institute on Drug Abuse at the National Institutes of Health. And, she serves on the Health Information Technology Policy Committee on Advanced Health Models and Meaningful Use for the U.S. Office of the National Coordinator. She also led the development of a seminal book from Oxford University Press on the state of the science of leveraging technologies in transforming behavioral health care.