Future of behavioral and mental health - week 3

Novartis to push software as a drug; Smartphone use in mental health treatments

Some time ago, I received a t-shirt as a gift that said: "I'm silently judging you." Now, no one wants to be judged nor do they want to amplify that they're guilty of passing judgment. But I've worn the t-shirt because it's witty since there's a lot of truth to it. We all, knowingly or not, pass judgment. 

So when I read this story about Amazon pulling products that trivialized those with mental health problems, to me, it was yet another symptom of our overly-sensitive culture that often neglects to understand human nature. When a t-shirt says, "I do what the voices in my head tell me," it's unclear how this pokes fun at those with mental health issues. Don't we all have voices in our heads? It's called our conscience. 

Nonetheless, we shouldn't trivialize the severity of mental disorders, particularly critical conditions like schizophrenia, bipolar disorders, post-traumatic stress disorder, or major depression disorder, and particularly mental disorders comorbid with chronic disease. Where it becomes dangerous and trivialized is when the mental illness spectrum expands to relatively healthy people dealing with life's vagaries that cause anxiety and sadness. For some, not all, mental illness is an excuse. The ones trivializing mental illness are the ones using it as a crutch, holding them back from improving their lives.

Thankfully, there are a number of new ways to treat common anxiety and stress, as well as treat and hopefully prevent serious mental health conditions. Technologies are being used to form support groups, communities, and match people with coaches and therapists. It takes a village (family, friends, community), and technology is helping us to recreate it. 

We'll discuss all this during our next salon: SplashX Invent Health - Behavioral and Mental Health - on June 21.

My co-hostesses are HP's Dr. Archana Dubey and Fran Ayalasomayajula. Dr. Dubey is global medical director at HP, overseeing hundreds of thousands of HP employees. She provides a great clinical perspective to these new solutions. Fran is the innovation lead at HP, spearheading new technology initiatives. 

If you're passionate about the topic, we hope you join us and contribute to the discussion.

Join us!

Our focus will be on services that affect behavioral change as a treatment to mental well-being from life's simple stresses to serious mental disorder comorbid with chronic illnesses. 

As a way for us to prepare for this topic, I'm writing weekly round-ups of interesting stories and reports that touch on this topic. I'll list them here along with my opinions. 

Novartis innovating with Pear Therapeutics

Walter Greenleaf, Chief Science Advisor at Pear Therapeutics, will join us on June 21 at our SplashX Invent Health - Behavioral and Mental Health salon. Here's some recent news about Pear and how it's becoming a game changer in the pharmaceutical industry. 

Pharmaceutical giant Novartis is making some inroads into digital therapeutics as it strikes multiple partnerships with Pear Therapeutics, a startup that's raised $80 million in VC financing to develop digital therapeutics, or "essentially software as a drug," as the firm's CEO Corey McCann puts it. This will be one collaboration to watch! Vasant Narasimhan, who in February 2018 took the helm as CEO of the No. 2 global drugmaker, based on sales, said there would be a technological revolution at the firm to boost its drug-development pipeline. Let's see how big software will be part of that pipeline. In March, Novartis teamed up with Pear Therapeutics on prescription software apps to treat schizophrenia and multiple sclerosis. Then last month, Novartis announced that its Sandoz unit would start selling and marketing Pear's reSET and reSET-O therapeutics. reSET is, according to Pear's website, the "first FDA-cleared prescription digital therapeutic for the treatment of patients with substance use disorder (SUD)" and reSET-O, which is designed to treat opioid use disorder (OUD). In September 2017, Pear announced that reSET was the first digital prescription therapeutic that was cleared by the US Food and Drug Administration. 

Both reSET and reSET-O are based on a type of cognitive behavioral therapy. "The 90-day mobile medical app system requires patients to complete modules similar to the training patients would get in face-to-face therapy sessions," according to the post, citing McCann.

Read more.

Leveraging smartphones in patient care

This piece looks at how smartphones are being used in psychiatric care, specifically  schizophrenia. Bottom line, there's still a lot more research to do, but phone sensors can pick up on a person's behavior or environment and show how those factors are affecting their clinical status. 

Dr. John Torous and Dr. Dror Ben-Zeev explore how smart phones are being used or could be used to gather data about the patient (via self-reporting or passive sensing via sensors) and deliver information to the patient. They refer to one study that had patients using a smartphone to track sleep, sociability (based on call and text logs), and activity (based on GPS and accelerometer sensors on the phone). In this study, the sensor data strongly correlated hallucinations with certain sleep patterns and noisy settings. This finding offers "new and unique opportunities to understand how a person's behavior and immediate environments may contribute to his or her clinical status," they write.

Smartphones may also offer a way to predict relapse, though research continues on this front. There also hasn't been any clear evidence that smartphones can be useful in lifestyle interventions, such as adopting better sleeping, eating and physical habits. On the positive side, some recent research shows that patients can record symptoms, which could help compensate for any memory loss they have when recounting those symptoms during visits. There's also evidence that text messaging has improved medication adherence. 

Finally, the post says that there's roughly 10,000 mobile apps that offer some sort of mental health apps - many espouse cognitive behavioral therapy and many are untested and of questionable clinical validity. To this end, patients can go to the American Psychiatric Association (APA) website for an evaluation of some apps.

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A primer on psychodynamic therapy

Cognitive behavioral therapy (CBT) simply put focuses on the way people think, which leads them to how they behave. CBT provides coping strategies to help people think about their current situation in a more positive way. Change in attitude leads to change in behavior. Instead of saying, "What's the point of trying?" With CBT, you teach yourself to say, "There's rewards for effort." According to nonprofit MDRC, "has proved effective for a variety of problems in hundreds of studies over the past 25 years." Cognitive therapy focuses on thoughts and belief while behavioral therapy focuses on changing unhelpful habits and reactions and reinforces positive behaviors. Combined they focus on thoughts that lead to emotions which then lead to behaviors. Thus the focus is on the thoughts and emotions. CBT is a common form of psychotherapy for depression and anxiety. It's also increasingly used for substance abuse and other risky behaviors since behavior can be traced to thoughts and perceptions that are learned, and therefore have the potential to change. Some successful CBT programs offered to people in jail (though the post doesn't say whether they received treatment while in jail or after leaving) showed that recidivism was cut in half.  

Read more.   

A good primer on social emotional learning

 

A new University of Michigan study, currently seeking patients, is researching whether cognitive behavioral therapy (CBT) improves brain function for patients with obsessive-compulsive disorder (OCD). 

"We are studying this by using brain imaging. We think that CBT is exercising the frontal cortex part of the brain. It may be that a more active and flexible frontal cortex helps OCD patients to dismiss obsessions as 'false alarms," said Kate Fitzgerald, M.D., associate professor with the university's Department of Psychiatry, who is running the study. 

The prefrontal cortex is an area in the brain that controls cognitive skills, such as emotional expression, decision making, problem solving, language and judgment. 

According to Fitzgerald, "one particular type of CBT, called exposure and response prevention, is effective for treating OCD. It teaches the patient to break the link between repetitive thought and ritualistic behaviors. By resisting the urge to perform a compulsive behavior, people with OCD learn that obsessive thoughts are insignificant, which lessens the anxiety that the thoughts produce... For example, if a person is worried about touching germs on a doorknob, I would have them touch it on purpose so that they can see nothing bad happened afterward. With practice, touching the doorknob becomes less scary, and the obsession that it will cause them to get sick starts to go away. The goal here is to get the patient to dismiss obsessive thoughts as 'garbage' that they can ignore."

By activating the prefrontal cortex, Fitzgerald says the patient is changing their perception. Fitzgerald didn't mention whether she's monitoring serotonin levels. Serotonin, a neurotransmitter that is a major modulator of the prefrontal cortez, is believed to regulate mood and desire. It's sometimes called the happy chemical because it contributes to wellbeing and happiness.

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 (Image sources: Mobilehealthnews, mhealth, pusulapdm, lifechangesgroup, casel.org, medicalnewstoday,, chummytees)