1. Realizing the Potential of CBT into the Digital Age - Understanding the Current Landscape, Opportunities, Pitfalls, and Needed Evidence Base
John Torous, Hannah Wisniewski, Ryan Hays
Beth Israel Deaconess Medical Center

2. Guiding Informed Decision Making
Torous et al., Current Psychiatry March;17(3):21-25

3. Causing Harm?
Bidargaddi N, Musiat P, Winsall M, Vogl G, Blake V, Quinn S, Orlowski S, Antezana G, Schrader G. Efficacy of a Web-Based Guided Recommendation Service for a Curated List of Readily Available Mental Health and Well-Being Mobile Apps for Young People: Randomized Controlled Trial. Journal of medical Internet research May;19(5).

4. Dichotomies in Digital Mental Health
Torous J, Haim A. Dichotomies in the Development and Implementation of Digital Mental Health Tools. Psychiatric Services Sep 27:appi-ps.

5. A Story Driven by Access
Patterson et al., American journal of preventive medicine Jun 30;54(6)

6. But Smartphone Access Does not Equal Mental Health Access

7. Even in College Students…
Study of 741 College Students Regarding Mental Health Apps.
26% “open to using”
81% preferred to see a person vs an app
7% had ever used a mental health app
Kern et al., mHealth. 2018;4.

8. Even in Businesses….

9. What Could Go Wrong?

10. Starcevic et al., Clinical Neuropsychiatry. 2017;14(1):5-10.
Internet “Addiction”
Is it a diagnosis?
Is it a comorbidity?
What is known today?
Starcevic et al., Clinical Neuropsychiatry. 2017;14(1):5-10.

11. Neuroimaging and Circuity Interpersonal Therapy Spectrum of Conditions
Potential
Pathophysiology
Research
Challenges
Clinical Definitions
Targeted Treatments
Co-morbidity
Frontal <-> Limbic
Neuroimaging and Circuity
Interpersonal Therapy
Structural Changes
Functional Changes
Heterogenous Definitions
Limited Sample Sizes
Lack of Longitudinal Data
Non-Representative Samples
CBT
Impulse Control
Behaviors
Single Condition
Sleep
Medications
Reward Deceits
Other Interventions
Anxiety
Exiting Constructs
Spectrum of Conditions
Addiction
Novel Treatments
Substance Abuse

13. Pilot vs Implementation
BibTeX
Gilbody et al., BMJ Nov 11;351:h5627.

14. Project Evo and ‘Dosing’
“This app is designed as a video game that modulates cognitive control abilities, a common neurological deficit seen in depression”
Arean PA, Hallgren KA, Jordan JT, Gazzaley A, Atkins DC, Heagerty PJ, Anguera JA. The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial. Journal of medical Internet research Dec;18(12).

15. Project Evo and ‘Dosing’
Arean PA, Hallgren KA, Jordan JT, Gazzaley A, Atkins DC, Heagerty PJ, Anguera JA. The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial. Journal of medical Internet research Dec;18(12).

16. Sleepio and Side Effects
Espie CA, Emsley R, Kyle SD, Gordon C, Drake CL, Siriwardena AN, Cape J, Ong JC, Sheaves B, Foster R, Freeman D. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA psychiatry Jan 1.

17. Apps Vs Control
Firth et al., Journal of affective disorders Aug 15;218:15-22.
Firth et al., World Psychiatry Oct;16(3):

18. App Active Ingredient…
Firth et al., World Psychiatry Oct;16(3):

19. Headspace and Digital Placebo
Noone and Hogan. A randomised active-controlled trial to examine the effects of an online mindfulness intervention on executive control, critical thinking and key thinking dispositions in a university student sample. BPJ Psychology. 2018

20. What do CBT Apps Do
Stawarz K, Preist C, Tallon D, Wiles N, Coyle D. User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews. Journal of medical Internet research. 2018;20(6):e10120.

21. What do CBT Apps Do
Stawarz K, Preist C, Tallon D, Wiles N, Coyle D. User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews. Journal of medical Internet research. 2018;20(6):e10120.

22. A Different Approach to CBT Apps

23. Rise of Digital Therapeutics

24. Digital CBT and the FDA….

25. New Regulatory Pathways

26. Let’s Go Backwards

27. JITAI: Linking Sensing to Interventions
Torous et al., Digital biomarkers. 2017;1(1):87-91.
Insel et al., JAMA Oct 3;318(13):

28. N=1 Dropping Out of CBT

29. Digital Phenotyping and Mood
Association of mobility ~ depressive symptoms was statistically significant for only one (of 30) participants
Bauer et al., Journal of Medical Internet Research. 2018;20(6):e10001.

30. Digital Phenotyping in Mood (Cont)
“After correcting for multiple comparisons, no significant association between semantic location and mood or anxiety.”
Saeb et al., JMIR mHealth and uHealth Aug;5(8).

31. Activity Symptoms Environment
Physical Activity
Symptom Surveys
Cognitive Testing
Time Stamps
Geo-Location / GPS

32. LAMP Tech Demo (Later)

33. Thank You!
Digitalpsych.org