Getting psychological help can be problematic in high-income countries like the Netherlands, where long waiting lists prevent many people from obtaining the help they need. However, in many low- and middle-income countries, access to mental healthcare is even more limited, with a large gap between needs and the care available. Guided technology-based interventions provide promising avenues for closing that gap, argues Professor dr. Claudi Bockting Amsterdam UMC, co-director of the Centre for Urban Mental Health at the University of Amsterdam, ‘They are indispensable in providing mental healthcare to the most vulnerable.’
Bockting studies different ways of providing people around the globe effective psychological care through technology. ‘For example, the World Health Organisation developed an intervention-chatbot to help distressed youth living in challenging conditions. At the moment we are studying its effect among Syrian refugees living in refugee camps in Jordan.’ The intervention, called Sustainable Technology for Adolescents and youth to Reduce Stress – or STARS, offers a range of psychological interventions through a user-friendly chatbot specifically designed to blend into the social lives of youth.
Emotional Inner Lives
STARS, like other technology-based interventions,incorporates aspects of both cognitive and behavioral therapy. Bockting: ‘It is common for people suffering from clinical depression to have negative automatic thoughts about everyday activities and seize the effort to undertake things. ‘I won’t bother going out, because it won’t do me any good and I’ll feel even more exhausted afterward.’ Subsequently they do nothing and feel even more sad. With behavioral therapy, we try to help people gradually break this vicious cycle by taking small steps to re-engage in life despite the lack of motivation or the negative feelings. We help patients identify small steps, that are also doable on a bad day, such as enjoying a warm shower or taking a moment to listen to the sound of the birds outside. Thereby we increase the chances of rewarding and positive experiences and gradually change theconditioning that sustains the depression.’
This digitized version of an intervention traditionally provided by professionals builds on promising outcomes in earlier studies of a technology-driven mental aid program, called Act and Feel. Bockting, with clinical psychologists Retha Arjadiand others, investigated an internet-based, personalized, automated program for people suffering from clinicaldepression in Indonesia. Bockting and her team tested the intervention in a large randomized control trial, where 313 participants suffering from depression were either assigned to the internet-based program guided by lay counselor support, or to a control condition where they simply received information about depression. The behavioral activationproved effective in reducing symptoms of depression, enhanced the chances of recovery by fifty percent, and showed sustainable positive effects over at least six months. Further analysis revealed that it was indeed the behavioral re-activation that prompted the improvements.
Furthermore, Junus van der Wal from the Centre of Urban Mental Health showed that the intervention was effective regardless of the socio-economic status of the Indonesian participants. Bockting: ‘That is crucial when trying to help those with limited possibilities of acquiring mental aid in other ways, although more studies are needed to sort this out for several low and middle income countries.’
While these findings are promising and were corroborated in a large meta-analysis, Bockting identifies pressing questions moving forward. ‘How do we use this knowledge to improve the accessibility to mental health care in high income countries? How will we systematically provide these servicesin the long run to people living in the most difficult situations?For example, to underserved populations in high income countries, as well as people living in refugee camps or under authoritarian regimes? And how do we ensure the intimate details patients share with a chatbot are securely stored and won’t get into the hands of authorities that might not safeguard the wellbeing of these people?’
Those are some of the questions addressed during the Symposium Societal Challenges, Global Mental Health and Humane AI hosted by the Centre for Urban Mental Health and the Institute for Logic, Language and Computation at SPUI25on January 9th, 2023.
Alongside Professor dr. Claudi Bockting, Professor dr. Vikram Patel of Harvard University will provide a keynote speech at the Symposium. Patel is one of the founders of the field of global mental health and spent his career trying to make psychological interventions available around the globe. The University of Amsterdam awards Patel an honorary doctorate in celebration of its Dies Natalis.
Follow this link for the full program and to register for the Symposium.