What makes a mental health professional recommend a CBT app?

Natasha Cowan, Amit Sheinholtz|6th August 2018

There is a growing concern about mental health issues in the UK. In the past year, 1.4 million people were referred to the National Health Service (NHS) for mental health support. This is impacting an already struggling healthcare system.

New data by the Royal College of Psychiatrists reveals access to care also varies wildly across the country. In London, there are 13 psychiatrists for every 100,000 people, while more rural areas have access to under half that number. To solve this problem, physicians are encouraging patients to manage their conditions with the help of apps. Many of which use a cognitive behavioural therapy (CBT) approach, which is most commonly used to treat anxiety and depression by changing negative patterns of thinking.

These digital tools help patients who can help themselves and free up mental health resources for those who need more advanced care. They have become a popular choice for the NHS due to their cost-effective nature, efficiency and the ability to measure the data. However, for an intervention to be recommended by healthcare professionals, it also has to be fit for purpose.

BLH Senior Associate UX Consultant Amit Sheinholtz specialises in Mental Health Apps. He was recently honoured with City University’s prestigious Department of Computer Science Outstanding Project Prize for his master’s thesis, in which he explored how mental health professionals evaluate, assess and choose CBT apps for their patients.

Here he talks us through his research and findings, as well as why good insight matters in this complex and saturated market.

The new era of interventions

Amit’s interest in mental health began at a young age. “I was always interested in human behaviour. I did my undergraduate degree in psychology as I originally wanted to become a clinical psychologist,” says Amit.

“After graduation, I took some time to explore other industries and I eventually found myself working in tech. I often wondered about the different ways in which technology is woven into our daily lives and into our physical and mental wellbeing in particular.

“When I applied for my master’s degree, I remember writing in my personal statement that it was my passion to explore the intersection between technology, therapy and well-being. One year later, towards the end of my studies, I saw that Blue Latitude Health was doing an internship in mental health apps, and everything came together. 

“The UK is failing to meet increasing demand for mental health and online interventions are filling the void left by scarce resources. Technology enables us to disseminate healthcare to people who otherwise might not have access to it.”

His award-winning master’s thesis delves deeper into the rationale behind mental health professionals’ choice of CBT app. More importantly, it also fills a void by establishing evidence-based design guidelines, which were previously non-existent.

“When you start thinking about conducting research, you have to carry out a thorough literature review to understand what is already out there and what is missing, in order to identify a well-documented gap. It was important for me to ensure that my work is current and relevant since the technology landscape is so fast-paced – apps rise just as quickly as they fall, and many products and services quickly become obsolete,” he explains.

Embracing the unexpected

He employed a contextual inquiry approach, using semi-structured interviews and naturalistic observations, to find out what mental health professionals really care about when it comes to recommending CBT apps.

During the study, mental health professionals were encouraged to interact with three apps: Catch It, the universities of Liverpool and Manchester’s simple mood diary tool; Pacifica, a detailed app with dual functionality for patients and clinicians (pictured above left and below right); and Woebot, an artificially intelligent chatbot therapist.

The mental health professionals were then interviewed to understand their experience of the apps, and their considerations for whether or not they made a recommendation. Amit knew the interviews had to feel natural as developing an understanding of the mental health professionals’ motivations was crucial to obtaining accurate findings.

“Personally, I believe context and flow are amongst the most important but also the most often overlooked parts of qualitative research,” says Amit.

“It comes back to the way our brain works. Essentially, it’s a large-scale network made up of smaller networks of neurons and synapses. When one starts to fire, other neurons in that network become active quicker. Providing your participant with the right context helps to prime them in a way that makes recollection easier and quicker for them.

“You could sit down with a participant and immediately ask them, ‘so, what aspects of CBT apps are the most important to you, before recommending them to a patient?’. That would probably catch them off guard, and it would take them a while to rummage around their memory and formulate their thoughts, resulting in more generic, superficial data.

“Instead, you should begin by asking your participant a broad and easy question. For example, ‘Can you briefly describe your role?’ or ‘What does your typical working day look like?’ and allow those job-related neural networks to start ‘waking up’ before getting to the more intricate questions.”

This is also where the flow – that organic movement forward of the conversation, comes into play.

“It’s always important to facilitate the interview in a way that feels natural for the participant, especially when opting for contextual inquiry. Maintaining flow involves moving from the general to the specific.

“More importantly, it’s about being able to react to what your participant said, acknowledge it, even spend a few minutes exploring that comment further, before steering the conversation back on track.

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