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New technological treatments that can improve mental health

New technological treatments that can improve mental health
Illustration: Efi Chalikopoulou / FT

From video games to personal avatars, researchers are trying to develop a new generation of digital tools that don't involve taking any drugs or therapy.

Source: The Financial Times
Translation: Telegrafi.com

Irene Jimenez Padilla was constantly suffering from flashbacks from her time as a nurse during the coronavirus pandemic. Then a computer puzzle game changed everything.


Padilla was plagued by memories centered on patients who had died painfully before her eyes at Guy's and St Thomas' hospitals in London. The images kept coming back like a "pesky fly that comes, again and again, buzzing, buzzing, buzzing," she recalls.

She found it impossible to control these disturbing memories until she signed up for an innovative play-based therapy Tetris. After a few weeks – playing the game that involves rotating blocks of different shapes and colors to fit together – the change was dramatic. She still remembered the events of the time of the coronavirus, but no longer experienced them in the way that caused her deep anxiety.

"It was so effective," she says of the digital calming effect that Tetris offered him. "All those faces, all those noises - they're gone."

method Tetris is part of a new frontier of mental health treatments that use new technologies and which are in their early stages offering promising results and new possibilities.

Motivated in part by the limitations of existing treatments – mostly drugs or psychotherapy – many researchers are trying to develop digital tools for treating mental health.

Miranda Wolpert, director of mental health at the charity Wellcome, says the new generation of techniques promises to be more accessible, scalable and potentially transformative for patients.

"We are now at a tipping point," says Wolpert. "The types of mental health interventions you'll see in five years may look very different from what you see now."

Like other innovative solutions to complex health problems, these technologies are in various stages of acceptance by regulators, clinicians and – most importantly – patients. In many cases, much larger studies will be needed to prove their effectiveness and cost-effectiveness.

But proponents of these new treatments believe there is a huge gap waiting to be filled because the increased global needs for mental health are outstripping the resources of traditional therapeutic approaches. Some illnesses, such as schizophrenia, remain particularly difficult to treat.

The impact of psychotherapy, although often apparent, can be difficult to measure objectively and is usually not monitored over time. Also, it is costly and time-consuming for many patients.

Meanwhile, there has been slow progress in discovering new drugs for mental health problems. When US regulators approved the schizophrenia drug KarXT in September, it was seen as the first truly groundbreaking treatment for the disease in more than 70 years.

Exaggerated attempts to use psychedelic drugs as a mental health treatment have also failed. Earlier this year, US authorities rejected the use of MDMA – the main ingredient in the drug ecstasy – to treat post-traumatic stress disorder (PTSD).

According to the US National Institute of Mental Health, technology has "opened a new frontier in mental health care and data collection". This government institute has awarded more than 400 grants for technology-enabled interventions.

David Crepaz-Keay, from the British charity the Mental Health Foundation, says one reason why researchers are exploring new technologies is because big data and artificial intelligence can play an important role in identifying populations. at risk and in enabling early interventions.

"Advances in technology and innovative thinking are transforming mental health care," says Crepaz-Keay, head of research and applied learning at the foundation. "Combined with apps, wearables and other digital tools, these innovations are expanding access and personalizing care, supporting the maintenance and protection of mental health."

One of the most impressive potential uses of digital tools is to help people who hear disturbing voices in their minds, a key symptom of psychosis.

Sufferers report constant monologues, which are often overly critical and may even suggest that they do not deserve to live. Existing treatments with drugs and psychological therapy are not always effective.

A potential alternative in development is Avatar therapy. In this therapy, the person creates a digital embodiment of what they think the voice they hear looks and sounds like. The individual then conducts conversations with the avatar, with the therapist providing the material for the dialogue.

A key insight of Avatar therapy is the element of control it offers the individual by bringing what was internal into an open form, says Tom Ward, a clinical psychologist at King's College London, who has been involved in Avatar Therapy experiments.

"What inspires this idea is that people who hear voices are experiencing a very convincing communication with another," says Ward. “But, by definition, this experience is not shared with anyone else – not a mental health professional, not a friend or anyone else. So it's a social experience that's also isolating."

The results of the research conducted by Ward and his colleagues were impressive. After 16 weeks, participants in the Avatar therapies reported improved mood and lower intensity of the voices they heard, compared to those who received the traditional therapies. Those who received extended Avatar treatment, tailored to their life story, heard voices less often than before.

Efforts are underway to see if Avatar therapy can be rolled out internationally. Trials of a version of the technology are planned in Ethiopia and India. Researchers are exploring the possibility of automating the avatar using artificial intelligence [AI], with the therapist providing support. Safeguards will be needed given the sensitive nature of the treatment and to ensure that the essential ingredients that make it effective are present.

"We hear relatively often from people who create an avatar that 'this is the first time I've really been able to share this experience with a mental health professional,'" says Ward. "So there is something in the act of creating the incarnation that offers this possibility."

New thinking in mental health also involves taking familiar old ideas and using them in new and surprising directions.

Researchers are examining therapies derived from electroconvulsive therapy (ECT), which has been used effectively for decades to treat major depression. In this therapy, electric current is sent to the brain to cause a temporary seizure. This treatment requires careful medical supervision, including general anesthesia, and patients and their relatives have often clashed with medical authorities over its use.

Scientists have studied whether it is possible to significantly reduce the dose of electricity. In October, researchers reported interesting results from a treatment known as transcranial direct current stimulation (tDCS). This method uses a weak current of two milliamps or less, compared to about 800 milliamps for ECT. This treatment results in a much milder, but potentially therapeutic, effect on the brain. This has made tDCS an option for supervised home use.

Participants suffering from at least moderate depression found the 10-week course of 36 half-hour sessions helpful, according to the study funded by the tDCS device manufacturer, Flow Neuroscience. About 45 percent reported relief from their condition, compared to less than 22 percent of a control group that used the device but did not receive the therapy.

This was not without negative side effects. Two patients reported experiencing "burning", possibly from using the dried sponges, the study said, although it added that these did not cause wounds.

The study showed that tDCS was a "potential first-line option that could help those in need," according to Cynthia Fu, the study's lead author and professor of affective neuroscience and psychotherapy at King's College London.

An even more direct use of electricity to treat severe depression is through the implantation of neural devices. Deep brain stimulation, with electrodes implanted through holes in the skull, is an experimental treatment that has produced some encouraging results. It resulted in a "rapid and sustained improvement in depression," says a study published in 2021.

But some doubts remain – including those of some scientists – whether this is a desirable option for long-term treatment, given how invasive it is. Risks come from both the surgery and possible side effects that follow from the treatment, such as vision problems, changes in mood, and speech difficulties.

The links between mental health and aspects of lifestyle are also a deep focus of interest. One of these is the science of sleep.

While sleep therapy mainly targets insomnia, which is thought to affect around one in ten people, more and more attention is being paid to the wider links between sleep and other conditions. Insomnia is thought to increase the risk of developing psychiatric disorders.

"There is a lot of research underway to understand how improvements in sleep and circadian rhythm disorders can help to improve mental health and reduce the risk of developing mental health problems," says Simon Kyle, professor at the Institute for Sleep. and Circadian Neuroscience at the University of Oxford.

Kyle's focus is known as sleep restriction therapy. Although this may sound like a counterintuitive answer to insomnia, the idea is to improve the quality of sleep by consolidating it and making it more stable. This is achieved by determining the optimal sleep start and end times for each patient, which they must then implement. These personalized rest schedules must be synchronized with biological sleep cycles.

Kyle and his colleagues successfully tested this approach in research published last year. About 42 percent of a group that received four brief sessions of nurse-delivered sleep restriction therapy reported clinically significant improvement in their insomnia. The study highlights the low cost of the therapy, as it does not require sleep specialists, and involved less than 90 minutes of nurse time for each participant.

Perhaps the most surprising innovation is the potential use of Tetrisfor improving mental health.

The game was developed four decades ago by Russian scientist Alexey Pajitnov and has become an obsessive hobby for some. A 2011 documentary titled Ecstasy of Order: Masters of Tetris [Ecstasy of Order: The Tetris Masters], recounts the struggles to win the world championship.

The ability of Tetris-it to absorb the attention of the players is essential for his new role in mental health. Emily Holmes, the leader of the group researching this, recalls being fascinated by "the way we think with images rather than words".

Holmes, a psychologist and neuroscientist at Uppsala University in Sweden, says she found similarities between the game and "the way trauma replays itself in the mind's eye, over and over again."

Traumatic flashbacks are not a "logical verbal representation of the world," Holmes argues, but constitute a "vivid set of images" that are often associated with memories.

"If, for example, you've been in a car accident with a red car, you can see fragments of that red car," she says, picking up and shaking an object from her desk by way of illustration. “My red pen may trigger an involuntary visual memory of a red car. So you're not even aware of what you're remembering."

Holmes focused on the "mental rotation" at its core Tetris-it, as a possible solution because of what brain activity scans suggest. The active parts of the brain during traumatic flashbacks are the same as those used during visual and spatial activity.

"You can't play Tetris and doing other visual things at the same time – the brain has a limited capacity,” says Holmes. "You can focus either on the traumatic image or on Tetris-i - but not both at the same time".

The theory is that the process of distraction from play makes the traumatic image more malleable, allowing it to reorganize in the mind in a less damaging form.

"You've faded this memory to the extent that, when it's reconsolidated into long-term memory, it's in a weaker form," Holmes says. "And, if it's less vivid and hyperperceptive, the next time you get a red trigger, you're less likely to have an involuntary memory of the red car."

Holmes and colleagues tested this approach in a study published last year. Participants listed their involuntary memories at the start of the study, and were then prompted to recall the image associated with one of them before the game session. After they played Tetris, for 20 minutes, they rated how they felt.

The effect became clear in less than a month. During the fourth week, participants who had immediate access to the intervention with Tetris, reported significantly fewer involuntary memories than those who did not use it. They also had fewer symptoms of PTSD, insomnia and anxiety, as well as an increase in work functioning and well-being.

Sophie, a British doctor, recalls her skepticism when she received a letter offering the chance to try the therapy with Tetris. As a doctor in a hospital's intensive care unit, she had felt strong episodes of worry about events during the coronavirus pandemic, involving dying patients and distraught relatives.

“I started thinking, 'How can playing a game help me? Tetris-i?'" says Sophie - who asked that her real name not be used - from the kitchen of her home in northwest England. "I was really negative about it. I was convinced that it was a waste of time."

Sophie found the easy approach to this treatment attractive. One of the greatest benefits of therapy Tetris was that – unlike a human interlocutor – she was available 24 hours a day. If she began to feel troubled by flashbacks, she could play it during a break at work, at home—even in the early hours of the morning if she woke up from a nightmare.

Within weeks, Sophie recalls noticing "a complete change in myself." She has not forgotten these terrible events, but is now able to remember and talk about them with a calmness that was previously impossible for her.

Even now, Sophie finds it hard to believe that something so trivial at first glance could be so effective. "I have to admit that it was successful even though I didn't expect it," she says. "That was really a surprise to me."

Treatment with Tetris it may be in its early stages and will need to undergo rigorous and much larger testing. But it illustrates how the next generation of therapies has the potential to be much more accessible and direct than before – with implications for many people seeking mental health help.

"You don't need drugs for this, you don't need a psychologist to talk about your life," says Padilla, who worked as a nurse during the pandemic. "It's that simple - you just sit in front of a computer and play Tetris". /Telegraph/

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