June 25, 2021
by Tina Arnoldi
Self-guided online mental health programs sound promising for people who may not choose to see a therapist for varying reasons. Digital marketer Girish Shukla says, “The internet has opened up new avenues for mental health treatment and has played a significant role in educating people.” But research coming out in the September 2021 issue of Internet Interventions shows the engagement with these programs is generally low. The results of this study suggests that more education is needed about the efficacy of online programs and that any benefits are dependent on the nature of the individual.
Dr. Crystal Shelton, DSW, LCSW-C developed self-guided mental health programs in the past and shares her general level of frustration with their design and usage. “These programs reflect a central disconnect between the developers of interventions and the consumers,” said Shelton. “It is an archaic model where the doctor knows best, and consumers are told these products meet a need that they clearly don't. These apps and programs are great for grants and development funding, but their utility and efficacy is rarely measured.”
A barrier to usage is also dependent on the presenting problems. “Two of the hallmark symptoms of depression and anxiety are reduced motivation and energy,” noted psychiatrist Jared Heathman, MD. “This results in difficulty with follow-through on self-guided activities.” The conflict is clear as depression and anxiety are common mental health disorders, yet also represent a group less inclined to seek professional help.
Heathman also sees a misperception on how quickly self-guided programs work. “Expectations are higher than reality which can result in quick discontinuation,” he said. “While self-engagement is important to recovery, a supportive and encouraging a counselor or psychiatrist is immensely helpful. Reinforcement of progress and realistic expectations help foster compliance.” Shelton agrees, “Web services exist because there are areas where people want to limit having to talk to a person, such as when they book a reservation, plan a trip etc. Those options emerged as part of consumer demand. But consumers never asked for personless therapy. Developers over estimated how much people want a process versus a connection.”
Therapist Catherine Hall, LMSW also is not surprised that engagement is low with self-guided online mental health treatments. “The therapeutic relationship is a determining factor in the outcome of the therapy, especially when the client’s mental health challenges have underpinnings in interpersonal trauma.”
Hall emphasizes that therapy is process-based, while self-guided programs are procedure-based. Hall added, “Successful treatment for common mental health issues like depression and anxiety requires dynamic, highly individualized treatment that psychotherapy offers, and it is the dynamic and individualized nature of therapy that keeps clients coming back.”
Chris McGuire, founder of Real Estate Exam Ninja, shared his personal experience with a mental fitness app and how he dropped out halfway through the first month. “It was nice how the videos and exercises were fully immersive,” explained McGuire, “but I got tired of checking in on the app to continue my progress. It just seemed monotonous and tedious.”
McGuire’s experience reflects a common finding in research trials of self-guided mental health programs. Previous studies of CBT programs found about half of users completed a program. It also depends on what led people to start using an app, whether they decided to try it on their own or a healthcare provider suggested it.
There is a need to increase the acceptance of these types of programs to increase engagement while also stressing they may not be the best solution for certain personality traits and clinical profiles. The above research findings suggested "those with higher levels of conscientiousness were more likely to access at least one module of the program.“ As the above experts noted, people with depression and anxiety may not be the best candidates for a self-guided program without supervision.