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Contributed: DTx DIY – How can reproducible clinical data help us meet mental health needs?


Sometimes myths walk among us. We would be wise to pay attention.

Dr Aaron Beck, considered the father of modern cognitive behavioral therapy (CBT), passed away last month, shortly after celebrating his 100th birthday. The historical life of Dr. Beck forces us to consider his pioneering work in further developing behavioral medicine and the need to extend that work to the current state of mental health treatment. in. What can we learn from Dr. Beck’s approach to generating evidence of the effectiveness of CBT in order to establish a similar model of scientific discipline for newer modalities such as digital therapy? DTx)? How does doing so enable effective, consistent, scalable solutions for mental health conditions to meet the growing need for mental health care?

Dr. Beck’s genius was to apply medical standards such as randomized controlled trials (RCTs) and quantifiable indicators of patient recovery to psychotherapy research, develop evidence-based effective validation methods of CBT for mental health conditions. Other clinical psychological scientists followed suit, and over the years, dozens of studies on CBT have supported its effectiveness for a wide range of psychological conditions, including depression, generalized anxiety, and anxiety. Post-traumatic stress disorder, obsessive-compulsive disorder, substance use disorder, and borderline personality disorder.

The reproducibility of the evidence supporting its effectiveness has earned CBT the confidence of healthcare professionals, patients, insurance companies, government agencies, and employers, all of which This has led to it being considered the first mental health treatment. For decades, pharmaceutical companies have used the same approach to establish the reliability of psychotropic drugs, which are determined largely on reproducible RCT evidence. It is clear that rigorous RCTs – where the highest levels of evidence are the result of appropriate study design and appropriate analytical techniques to minimize bias in results – are the gold standard of legitimacy. of research and treatment.

However, despite Dr. Beck’s groundbreaking career, he has not been able to solve our current mental health crisis. The structural and logistical constraints of direct community-based tourism and the high cost do not adequately address growing mental health needs, further increasing inequalities in access to care. squirrel: Thirty-seven percent of the population of the United States, 122 million people, live in areas where there is a shortage of mental health professionals. Even when individuals have access to a therapist, they do not always receive evidence-based care. Scaling the supplier’s supply in the short and even long term is impractical. And in most areas of the country, therapy costs an average of $100 to $200 per visit, well beyond what most people who need care can afford. In addition to logistical and cost issues, societal stigma surrounding mental health issues and seeking help is most acutely felt by marginalized populations ( e.g. Black, Latinx, LGBTQ+ and disabled communities) and may discourage individuals from participating in traditional therapy.

Psychiatric medications, the most commonly provided mental health treatments, are highly scalable, but the presence of side effects, the potential for dependence, and minimal long-term benefit for certain medications that limit their ability to address the stress needs and root causes of mental health conditions. In fact, 82% of patients is receiving mental health treatment. Add research has shown that more than half of people using selective serotonin reuptake inhibitors (SSRIs) may experience moderate to severe adverse events within two weeks of treatment. Benzodiazepines and codeine, commonly prescribed for anxiety and sleep disorders, have the strongest FDA black box warnings due to their potential safety hazards.

Even when the drug is prescribed, from research that harmful racial bias can hinder prescribing patterns. Blacks and Hispanics were more likely to be prescribed benzodiazepines, a common anxiety medication that includes Xanax, which is discontinued even when there are no signs of abuse. Furthermore, the majority people of color surveyed in a study reported experiencing violations in psychotherapy. These alarming practices severely limit treatment options for people of color.

The combination of these factors suggests that currently established pharmacy and community-based tourism approaches have resulted in too few people accessing the most effective, evidence-based care.

While Dr. Beck’s research is a product of the digital currency world, technological advances in medicine are increasingly turning to mental health treatment, including DTx – Clinically evaluated software delivers significant health outcomes and can be delivered alongside medication. DTx’s attributes of scalability, accessibility, direction, and affordability can help close the mental health care gap, create greater equity, and save millions from pain suffering in silence.

However, to fulfill that promise, the proven model of reproducibility established by Dr. Beck must be adopted by the DTx industry, with RCTs directly testing its unique, digital intervention modality. Relying on the replicability of in-person CBT alone is not enough to establish that digital CBT is currently leading to substantial and sustainable improvements in mental health.

Conducting and publishing rigorous, replicable studies is the approach that must become standard in the DTx industry if it is to ever become a legitimate option alongside CBT and drugs. Unfortunately, many in the DTx have not done enough to comply with the RCT gold standard. In any other medical practice, if you create a new model, you must publish the gold standard clinical study and demonstrate significant clinical results. We in DTx have to do the same, focusing on providing concrete evidence on how to get results consistent. Individual companies that fail to adopt this approach will be left behind, but the consequences will also damage DTx by damaging its growing reputation and undermining its potential to offer scalable, cost-effective solutions for the growing need for mental health care.

I was fortunate to witness the final chapters of Dr. Beck’s remarkable life. Without his work, mental health treatment wouldn’t be able to help as many people. However, in the same breath, I will present a challenge: Who is ready to be Aaron Beck for DTx? Before the next 100 years are over, who will be recognized as mother or father or digital therapy? Will it be me? Will it be you?


Dr. Juliette McClendonJuliette McClendon is a clinical psychologist with expertise in the research and treatment of mood, anxiety, and personality disorders. She is a nationally recognized expert on racial and ethnic health disparities and has worked extensively to address the impact of stress and trauma on the mental and physical health of people of color. . Prior to joining Big Health, McClendon was an assistant professor of psychiatry at Boston University School of Medicine and a psychologist at the National Center for PTSD in the Women’s Health Sciences Division of the Care System. Veterans Health (VA) Boston.

In 2020, McClendon was named a National Institute of Health Disparities Scholar by the US National Institutes of Health (NIH). McClendon holds an undergraduate degree in psychology from Harvard University and a master’s and doctorate from Washington University in St. Louis in clinical psychology, focusing on racial and ethnic health disparities.



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