Speedy mini-apps are designed to address depression and anxiety
Soon you can seek mental health advice on your smartphone as quickly as finding a good restaurant.
A novel suite of 13 speedy mini-apps called IntelliCare resulted in participants reporting significantly less depression and anxiety by using the apps on their smartphones up to four times a day, reports a new Northwestern Medicine study.
The apps offer exercises to de-stress, reduce self-criticism and worrying, methods to help your life feel more meaningful, mantras to highlight your strengths, strategies for a good night’s sleep and more.
Most apps designed for mental health typically offer a single strategy to feel better or provide too many features that make them difficult to navigate. Users may get bored or overwhelmed and may stop using the apps after a few weeks.
But participants robustly used the IntelliCare interactive apps as many as four times daily — or an average of 195 times — for eight weeks of the study. They spent an average of one minute using each app, with longer times for apps with relaxation videos.
The 96 participants who completed the research study reported that they experienced about a 50 percent decrease in the severity of depressive and anxiety symptoms. The short-term study-related reductions are comparable to results expected in clinical practice using psychotherapy or with that seen using antidepressant medication.
The study was published Jan. 5 in the Journal of Medical Internet Research.
“We designed these apps so they fit easily into people’s lives and could be used as simply as apps to find a restaurant or directions,” said lead study author David Mohr, professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine.
“Some of the participants kept using them after the study because they felt that the apps helped them feel better,” Mohr said. “There were many apps to try during the study, so there was a sense of novelty.”
Participants had access to the 13 IntelliCare apps from Google Play and received eight weeks of coaching for the use of IntelliCare. Coaching included an initial phone call plus two or more text messages per week over the eight weeks. In the study, 105 participants were enrolled and 96 of them completed the study.
The preliminary study did not include a control arm, so it’s possible that some people who enrolled in the trial would have improved anyway, partly because they may have been motivated to try something new, Mohr said. He now has launched a larger trial, recruiting 300 participants, with a control arm.
Some of the IntelliCare apps include:
Daily Feats: designed to motivate you to add worthwhile and rewarding activities into your day to increase your overall satisfaction in life.
Purple Chill: designed to help you unwind with audio recordings that guide you through exercises to de-stress and worry less.
Slumber Time: designed to ease you into a good night’s rest.
My Mantra: designed to help you create motivating mantras to highlight your strengths and values.
“Using digital tools for mental health is emerging as an important part of our future,” Mohr said. “These are designed to help the millions of people who want support but can’t get to a therapist’s office.”
More than 20 percent of Americans have significant symptoms of depression or anxiety each year, but only around 20 percent of people with a mental health problem get adequate treatment.
The IntelliCare algorithm recommends new apps each week to keep the experience fresh, provide new opportunities for learning skills and avoid user boredom. Although the apps are not validated, each one was designed by Northwestern clinicians and based on validated techniques used by therapists.
IntelliCare is a national research study. Individuals can download the apps free with no financial obligation. But Northwestern researchers hope participants will provide confidential feedback, via four weekly questions, that will be used to further develop the system. The data will help the system make even better recommendations and provide more personalized treatment.
People also may enroll in a study in which they will be paid to provide even more feedback. Some also will have access to an IntelliCare coach via text messaging and phone calls, who are available to support them in using the apps.
“We now have evidence these approaches will likely work,” Mohr said. “They are designed to teach many of the same skills therapists teach patients. Different apps are expected to work for different people. The goal is to find what’s right for you.”
Participants using a game-based app report benefits
Researchers have found promising results for treating depression with a video game interface that targets underlying cognitive issues associated with depression rather than just managing the symptoms.
“We found that moderately depressed people do better with apps like this because they address or treat correlates of depression,” said Patricia Areán, a UW Medicine researcher in psychiatry and behavioral sciences.
The first study enrolled older adults diagnosed with late-life depression into a treatment trial where they were randomized to receive either a mobile, tablet-based treatment technology developed by Akili Interactive Labs called Project: EVO or an in-person therapy technique known as problem-solving therapy (PST).
Project: EVO runs on phones and tablets and is designed to improve focus and attention at a basic neurological level. The results, published Jan. 3 in the journal Depression and Anxiety, showed that the group using Project: EVO demonstrated specific cognitive benefits (such as attention) compared to the behavioral therapy, and saw similar improvements in mood and self-reported function. Joaquin A. Anguera, a University of California, San Francisco (UCSF), researcher in neurology and psychiatry, is the lead author, and Areán is the senior author. The researchers have no commercial interests in the intervention manufactured by Akili Interactive Labs in Boston. The studies were funded by the National Institute of Mental Health.
“While EVO was not directly designed to treat depressive symptoms; we hypothesized that there may indeed be beneficial effects on these symptoms by improving cognitive issues with targeted treatment, and so far, the results are promising,” said Anguera.
People with late-life depression (60+) are known to have trouble focusing their attention on personal goals and report trouble concentrating because they are so distracted by their worries. Akili’s technology was designed to help people better focus their attention and to prevent people from being easily distracted.
Arean said most of the participants had never used a tablet, let alone played a video game, but compliance was more than 100 percent. The participants were required to play the game five times a week for 20 minutes, but many played it more. Participants in this arm of the study also attended weekly meetings with a clinician. The meetings served as a control for the fact that participants in the problem-solving therapy arm were seen in person on a weekly basis, and social contact of this nature can have a positive effect on mood.
A second study, which was another joint effort by UW and UCSF, randomized more than 600 people across the United States assessed as moderately or mildly depressed to one of three interventions: Akili’s Project: EVO; iPST, an app deployment of problem-solving therapy; or a placebo control (an app called Health Tips, which offered healthy suggestions).
Areán, the lead researcher on the study published Dec. 20 in the Journal of Medical Internet Research (JIMR), found that people who were mildly depressed were able to see improvements in all three groups, including the placebo. However, those individuals who were more than mildly depressed showed a greater improvement of their symptoms following their use of Project EVO or iPST versus the placebo.
Areán said much of her research is aimed at providing effective treatment to people who need it, and these results provide great potential for helping people who don’t have the resources to access effective problem solving therapy. But, she stressed, the apps should be used under clinical supervision because without a human interface, people were not as motivated to use it. In the JIMR study, 58 percent of participants did not download the app.
Akili’s technologies are based on a proprietary neuroscience approach developed to target specific neurological systems through sensory and digital mechanics. The company’s technology platform used in this trial is based on cognitive science exclusively licensed from the lab of Dr. Adam Gazzaley at UCSF, and adaptive algorithms developed at Akili, which are built into action video game interfaces. The technology targets an individual’s core neurological ability to process multiple streams of information.
Project: EVO is undergoing multiple clinical trials for use in cognitive disorders — including Alzheimer’s disease, traumatic brain injury and pediatric attention deficit hyperactivity disorder (ADHD), and the company is on path for potential FDA clearance to treat pediatric ADHD.
In a small double-blind study, Johns Hopkins researchers report that a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.”
The researchers cautioned that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient care setting.
The Johns Hopkins team released its study results, involving 51 adult patients, concurrently with researchers from New York University Langone Medical Center, who conducted a similarly designed study on 29 participants. Both studies are published in the Journal of Psychopharmacology on Dec. 1.
The Johns Hopkins group reported that psilocybin decreased clinician- and patient-rated depressed mood, anxiety and death anxiety, and increased quality of life, life meaning and optimism. Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range. Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events.
“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” says Roland Griffiths, Ph.D., professor of behavioral biology in the Departments of Psychiatry and Behavioral Sciences and of Neuroscience at the Johns Hopkins University School of Medicine. He notes that traditional psychotherapy offered to people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, isn’t always effective, and in the case of some drugs, such as benzodiazepines, may have addictive and other troubling side effects.
Griffiths says his team’s new study grew out of a decade of research at Johns Hopkins on the effects of psilocybin in healthy volunteers, which found that psilocybin can consistently produce positive changes in mood, behavior and spirituality when administered to carefully screened and prepared participants. The study was designed to see if psilocybin could produce similar results in psychologically distressed cancer patients.
“A life-threatening cancer diagnosis can be psychologically challenging, with anxiety and depression as very common symptoms,” says Griffiths. “People with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death.”
For the study, the investigators recruited 51 participants diagnosed with life-threatening cancers, most of which were recurrent or metastatic. They were chosen from a total of 566 individuals reached through flyers, web advertisements and physician referrals. Most participants had breast, upper digestive, GI, genitourinary or blood cancer, and each had been given a formal psychiatric diagnosis, including an anxiety or depressive disorder.
Half of the participants were female with an average age of 56. Ninety-two percent were white, 4 percent were African-American and 2 percent were Asian.
Each participant had two treatment sessions scheduled five weeks apart, one with a very low psilocybin dose (1 or3 milligrams per 70 kilograms) taken in a capsule and meant to act as a “control” placebo because the dose was too low to produce effects. In the other session, participants received a capsule with what is considered a moderate or high dose (22 or 30 milligrams per 70 kilograms).
To minimize expectancy effects, the participants and the staff members supervising the sessions were told that the participants would receive psilocybin on both sessions, but they did not know that all participants would receive one high and one low dose. Blood pressure and mood were monitored throughout the sessions. Two monitors aided participants during each session, encouraging them to lie down, wear an eye mask, listen to music through headphones and direct their attention on their inner experience. If anxiety or confusion arose, the monitors provided reassurance to the participants.
In addition to experiencing changes in visual perception, emotions and thinking, most participants reported experiences of psychological insight and often profound, deeply meaningful experiences of the interconnectedness of all people.
The researchers assessed each participant’s mood, attitude about life, behaviors and spirituality with questionnaires and structured interviews before the first session, seven hours after taking the psilocybin, five weeks after each session and six months after the second session. Immediately after the sessions, participants completed questionnaires assessing changes in visual, auditory and body perceptions; feelings of transcendence; changes in mood; and more.
Structured clinical interviews, such as the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, and patient questionnaires, like the Beck Depression Inventory and the State-Trait Anxiety Inventory, assessed depression and anxiety. Other questionnaires assessed quality of life, death acceptance, meaningful existence, optimism and spirituality — generally defined as a search for the meaning of life and a connection to something bigger than one’s self. To measure the changes in attitudes, moods and behavior over time, the researchers administered a questionnaire that assessed negative or positive changes in attitudes about life, mood and behavior.
With regard to adverse effects, Griffiths says 15 percent of participants were nauseated or vomited, and one-third of participants experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose. One-third of the participants had transient increases in blood pressure. A few participants reported headaches following the session.
“Before beginning the study, it wasn’t clear to me that this treatment would be helpful, since cancer patients may experience profound hopelessness in response to their diagnosis, which is often followed by multiple surgeries and prolonged chemotherapy,” says Griffiths. “I could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful. However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.”
Up to 40 percent of people with cancer suffer from a mood disorder, according to the National Comprehensive Cancer Network.
Anticipating wide interest in the psilocybin research from scientists, clinicians and the public, the journal solicited 11 commentaries to be co-published with the study results written by luminaries in psychiatry, palliative care and drug regulation, including two past presidents of the American Psychiatric Association, a past president of the European College of Neuropsychopharmacology, the former deputy director of the U.S. Office of National Drug Control Policy, and the former head of the U.K. Medicines and Healthcare Products Regulatory Authority. In general, the commentaries were supportive of the research and of using these drugs in a clinical setting as tools for psychiatry.
In Penn State’s newest and most advanced research building, a new program is taking shape that, if successful, will revolutionize the ways in which we interact with the human brain. Led by Srinivas Tadigadapa, an electrical engineer, and Steve Schiff, a neurosurgeon with a background in physics and control engineering, this ambitious project exemplifies the convergence of research fields that are typically separated by distinct disciplinary boundaries.
In 2013, the Obama White House laid out a grand challenge to “accelerate the development and application of new technologies that will enable researchers to produce dynamic pictures of the brain that show how individual brain cells and complex neural circuits interact at the speed of thought.” Called the BRAIN Initiative, it is a 12-year plan to fund research into understanding the brain on multiple levels, using a variety of new and developing technologies. With these tools, it is hoped that the many diseases and malfunctions that afflict the brain can be controlled or eliminated. Schiff and Tadigadapa recently won one of Penn State’s two exploratory BRAIN awards.
A transdisciplinary team to solve a monumental problem
Steve Schiff has the soothing voice and gentle manner of someone who has spent a large part of his career dealing with children, and frequently, children in pain. As a pediatric neurosurgeon, he has leant his skills and bedside manner to treating diseases of the brain in children, but as a researcher he is adding another skill set, one based on his background in engineering and physics, to develop technology to understand and control diseases of the brain.
Schiff is director of the Penn State Center for Neural Engineering, a lab that takes up an entire floor of the Life Sciences wing of the Millennium Science Complex on Penn State’s University Park campus. A series of card-swipe controlled laboratories make up the 11,000-square-foot Center, with facilities for the construction of custom electronics, live animal imaging, surgery, and advanced computerized microscopy. His Center colleagues include medical doctors, engineers and biomedical engineers, and the graduate students they are training.
In the Materials wing of the building in a basement micro and nanoscale devices laboratory, Tadigadapa’s group is developing microelectromechanical systems (MEMS) that miniaturize device arrays for sensing and actuating, some of which the team hopes will one day be implanted into the human skull in order to explore the brain on a cell-by-cell basis.
Brain scans may identify children who are vulnerable to depression, before symptoms appear
A new brain imaging study from MIT and Harvard Medical School may lead to a screen that could identify children at high risk of developing depression later in life.
In the study, the researchers found distinctive brain differences in children known to be at high risk because of family history of depression. The finding suggests that this type of scan could be used to identify children whose risk was previously unknown, allowing them to undergo treatment before developing depression, says John Gabrieli, the Grover M. Hermann Professor in Health Sciences and Technology and a professor of brain and cognitive sciences at MIT.
Read more: Diagnosing depression before it starts
A single dose of psilocybin, the major hallucinogenic component in magic mushrooms, induces long-lasting decreases in anxiety and depression in patients diagnosed with life-threatening cancer according to a new study presented today at the annual meeting of the American College of Neuropsychopharmacology.
Patients who receive a cancer diagnosis often develop debilitating symptoms of anxiety and depression. Reports from the 1960s and 1970s suggest that hallucinogenic drugs such as LSD may alleviate such symptoms in cancer patients, but the clinical value of hallucinogenic drugs for the treatment of mood disturbances in cancer patients remains unclear. In this new study, Roland Griffiths and colleagues from the Johns Hopkins University School of Medicine investigated the effects of psilocybin on symptoms of anxiety and depression in individuals diagnosed with life-threatening cancer. Five weeks after receiving a dose of psilocybin sufficiently high to induce changes in perception and mystical-type experiences, patients reported significantly lower levels of anxiety and depression compared with patients that received a low dose of the drug. The positive effects on mood persisted in the patients at 6 month follow-up.
The authors suggest that a single dose of psilocybin may be sufficient to produce enduring decreases in negative mood in patients with a life-threatening cancer.