Technological Innovations for PTSD
IndustryView | 2014
Seven to 8 percent of Americans will be affected by post-traumatic stress disorder (PTSD) over the course of their lives. But according to the National Institute for Mental Health (NIMH), only half of adults suffering receive treatment.
However, barriers to treatment—such as the perceived stigma of mental illness, busy schedules and limited access to services—are being broken down by the growing body of technology developed specifically for mental health. We investigated four cutting-edge methods for identifying and treating PTSD, and interviewed experts to explore how these technologies are affecting mental health care.
Using technology to treat mental illness is not a new concept. Virtual Vietnam, developed in the late 1990s by a joint partnership between Georgia Tech, Emory University and the U.S. Department of Veteran’s Affairs (VA) hospital in Atlanta, pioneered the use of exposure therapy through virtual reality to treat Vietnam veterans with PTSD. Exposure therapy, which was pioneered in the 1950s as a treatment for phobias, typically involves exposing the patient to gradually stronger stimuli until their fear response is reduced. Studies have shown that exposure therapy is an effective way of reducing the symptoms of PTSD.
While Virtual Vietnam never quite took off as a treatment method, as newer and more advanced technology became available, other psychologists began considering the use of virtual reality for returning veterans.
Skip Rizzo, professor of psychology at the University of Southern California and director of the medical virtual reality lab at the Institute for Creative Technologies (ICT), started thinking about developing a virtual reality system for PTSD at the start of the Iraq war in 2003.
“We said ‘mission accomplished,’” he says, “but it didn’t look that way to me.”
After developing and testing a prototype in Iraq later that year, Rizzo received funding in 2005 to develop Virtual Iraq/Afghanistan. And the need was there: The VA predicts that as many as 20 percent of veterans return from the Middle East with PTSD symptoms.
With virtual reality, instead of having to imagine a traumatic scenario and recount it from memory, patients can become immersed in video-game style worlds via a headset. Visual scenarios and sounds within the simulation, such as explosions or a call to prayer, are controlled by a trained mental health professional.
However, the immersive nature of this treatment has caused some to criticize virtual reality on the grounds that it creates too much distance between the patient and the clinician.
“I know that there are some people [who] feel like by using [virtual reality], you’re sacrificing the patient-clinician relationship,” explains Rizzo. “[But] you can build a relationship, share an experience, when you have a common visual world [in the form of a simulation] to explore.”
And for veterans who may not be interested in traditional talk therapy, this visual world has become another path for seeking treatment. Virtual Iraq and Afghanistan simulations have been deployed in over 65 VA hospitals and clinics, military bases and private clinics, and are coming soon to 12 to 13 more locations. With future potential for civilians suffering from trauma, virtual reality may soon become a standard for PTSD treatment.
Before patients with PTSD can receive such treatments as virtual reality simulations, they need to be informed about symptoms and treatment resources available in their area. Mobile apps—widely accessible via download from Apple’s iTunes store or Google Play—are becoming another way of reaching people seeking information about PTSD.
One app developed by the VA and Department of Defense, PTSD Coach, seeks to provide veterans and civilians alike with valuable information on the symptoms and treatment of PTSD. According to the U.S. Department of Veterans Affairs, it has been downloaded over 100,000 times in 79 countries since being released in 2011.
“If [mobile applications are] a place where our patients are looking for support, we want to be there to meet them,” explains Dr. Julia Hoffman, national director of mobile health at the VA and one of PTSD Coach’s main developers.
The app contains four core features: educational materials, a self-assessment, links to support resources and a tool for managing acute distress. Dr. Hoffman noted that the latter feature, designed for managing moments of crisis, was one that veterans specifically requested.
“The number-one thing that they wanted was something to do, in the moment, when they were feeling stress,” she explains.
Tools for managing acute distress are categorized within the app by the symptoms that a person is currently experiencing—for example, “reminded of trauma," “disconnected from people” or “disconnected from reality." Quick access to resources in the moment of distress allows patients to engage in treatment without a provider being present.
For patients who might otherwise not have access to adequate treatment, mobile solutions provide tools for both managing symptoms the moment they happen and finding resources for further help.
Another platform providing people with PTSD access to mental health care is telemedicine. Quickly becoming a popular option for healthcare services, mental health and substance abuse treatment provided by a licensed professional can now be found online.
Although telemedicine companies in the mental health field offer different services, the one unifying theme is that they provide quick access to a licensed therapist via a HIPPA-compliant online messaging system, video chat or even text messaging.
“The typical, traditional form of therapy that we’re compared to is face-to-face [treatment], where patients come in for an hour a week,” explains Nicole Amesbury, Head of Clinical Psychology at Talkspace, a company offering teletherapy services. “This is very much the same, where you have a licensed clinician coming into a room. The difference is that you can access that room 24 hours a day, at your computer. You can see your therapist without making an appointment; without paying for transportation; without going to an office.”
However, the benefits of having a therapist available 24/7 through multiple communication channels could be somewhat offset by the physical distance between therapist and patient. Amesbury says she often has patients asking her if she is "real," and notes that it may be more challenging to show the human connection when using an online platform.
However, a study conducted by the National Institute for Mental Health suggests that online therapy may lessen PTSD symptoms.
“Over the next five years, I think we’ll see this become a norm,” predicts Julian Cohen, CEO of Breakthrough, another company that offers teletherapy services. “I don’t believe it’s an either/or scenario—I think there are legitimate reasons why someone should be seen face-to-face or online. I think it’s an individual decision.”
What if a computer could identify symptoms of PTSD before a patient thought about seeking help? The field of sentiment analysis, which is used to determine the attitude or emotional state of the author, offers a new way to identify patients who are showing signs of mental illness.
“A technological solution is clearly a very useful tool to quickly screen a large number of potential PTSD sufferers,” explains Vadim Kagan, founder of data science firm Sentimetrix. One of the company’s current projects involves developing an algorithm to detect symptoms of PTSD in people who may not have noticed their condition.
Sentimetrix’s algorithm identifies words and phrases from a person’s blog posts, tweets and Facebook status updates that are correlated with the PTSD diagnostic criteria from the Deployment Health Clinical Center (DHCC), a branch of the Department of Defense seeking to improve deployment health care. For instance, if a person writes that they “always feel anxious”, the algorithm would assign a value for anxiety based on the severity of the symptom described.
The system has a high degree of accuracy, agreeing with the diagnosis of a human professional 85 percent of the time.
“The system is not intended to replace human psychologists,” notes Kagan, ”but rather to more efficiently identify people who may be suffering from PTSD and are not aware of their condition.”
Computerized tools such as Sentimetrix’s algorithm could be used by mental health professionals to screen large numbers of people at risk for PTSD faster than human beings could. Considering the shortage of mental health professionals in some parts of the country, sentiment analysis is another way for the VA and other institutions to identify veterans who are at risk of going without treatment.
With national institutions such as the VA and private providers struggling to meet the increased demand for mental health services, technology is rising to meet the challenge.
“The good news is that, as technology has become a more normal part of our lives, clinicians are finding that it is a way to reduce stigma [and] get to a patient; it increases accessibility,” explains Cohen.
This positive outlook was shared by Dr. Hoffman, who points out that as our comfort level with technology increases, so does the willingness of providers to use new, technology-based forms of treatment. For the mental health field, the challenge will be balancing accessibility and speed with the ability to provide a truly human experience.
"Virtual Reality" created by 807th Medical Command (Deployment Support).
“Bravemind” created by the Institute for Creative Technologies.
Screenshots of PTSD Coach created by the U.S. Department of Veterans Affairs.
Screenshot of Talkspace created by Nicole Amesbury.
Screenshot of Sentimetrix created by Vadim Kagan.