Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future

Half title
Title
Copyright
Contents
Contributors
Foreword
Chapter 1 Introduction: A vision for the field of digital therapeutics
	1.1 Why read this book?
	1.2 Who is this book for?
	1.3 What topics are covered in this book?
		1.3.1 First section: Introduction to digital therapeutics
		1.3.2 Second section: The new frontier
		1.3.3 Third section: Structural considerations
	1.4 What will readers learn?
Chapter 2 Using digital therapeutics to target gaps and failures in traditional mental health and addiction treatments
	2.1 Prevalence and impact of mental health and substance use disorders
	2.2 Lack of treatment receipt in the traditional care system
	2.3 Barriers to traditional treatment: stigma, personal beliefs, and cultural competence
	2.4 Barriers to traditional treatment: cultural competence
	2.5 Barriers to traditional treatment: high cost and lack of insurance coverage
	2.6 Barriers to traditional treatment: transportation and appointment time availability
	2.7 Barriers to traditional treatment: inadequate number of mental health providers
	2.8 Barriers to traditional treatment: patient narratives
	2.9 Leveraging digital therapeutics to transform treatment models for mental health and substance use disorders
	2.10 A time of opportunity to transform models of mental health and substance use care via digital therapeutics
	References
Chapter 3 First wave of scalable digital therapeutics: Internet-based programs for direct-to-consumer standalone care for mental health and addiction
	3.1 Development of internet-based programs
		3.1.1 Internet-based programs versus mobile applications
	3.2 Internet-based programs for substance use disorders
		3.2.1 Therapeutic education system
		3.2.2 The CHESS-ACHESS program
		3.2.3 CBT4CBT
		3.2.4 Dual diagnosis patients
		3.2.5 Prevention and screening
	3.3 Internet-based programs for mental health \(nonsubstance related disorders\)
		3.3.1 Mood and anxiety disorders
	3.4 Summary and next steps for internet-based programs for substance use and mental health disorders
	References
Chapter 4 Second wave of scalable digital therapeutics: Mental health and addiction treatment apps for direct-to-consumer standalone care
	4.1 Overview of second-wave digital therapeutics
	4.2 Evidence base for second wave digital therapeutics
		4.2.1 Evidence base for mood tracking apps
		4.2.2 Evidence base for online peer communities
		4.2.3 Evidence base for serious games
	4.3 Cautions and limitations with second-generation digital therapeutics
	4.4 How to find effective second-wave digital therapeutics
	4.5 How to use second-wave digital therapeutics in practice
	4.6 Summary and future directions
	References
Chapter 5 Blending digital therapeutics within the healthcare system
	5.1 Introduction
	5.2 Blended care terminology
		5.2.1 Internet-delivered treatments
		5.2.2 Blended care
	5.3 Components and structure of blended care
		5.3.1 Therapeutic support
		5.3.2 Digital components
		5.3.3 Structure of blended care
	5.4 Blended care treatment approaches
	5.5 Development and value of blended care
		5.5.1 Development of blended care treatments
		5.5.2 Value of blended care
	5.6 Illustrations
		5.6.1 Examples of blended care interventions for MHD adapted for the use in the healthcare system
		5.6.2 Examples of BC interventions for SUD adapted for use in the healthcare system
	5.7 Challenges to the adoption of blended care
	5.8 Future directions and conclusions
	References
Chapter 6 Receptivity to mobile health interventions
	6.1 Introduction
	6.2 The anatomy of an “ideal” mobile health intervention
	6.3 Key processes of receptivity: receiving, processing, and using support
	6.4 What do we already know about states of receptivity?
	6.5 Challenges and future work
	References
Chapter 7 Adapting just-in-time interventions to vulnerability and receptivity: Conceptual and methodological considerations
	7.1 Introduction
	7.2 Just-in-time adaptive interventions
	7.3 JITAI components
	7.4 States of vulnerability and receptivity
	7.5 Scientific questions about vulnerability and receptivity in just-in-time intervention development
	7.6 Analyzing observational ILD to inform JITAI development
	7.7 Analyzing ILD from microrandomized trials
	7.8 Conclusion
	Acknowledgments
	References
Chapter 8 A digital therapeutic alliance in digital mental health
	8.1 Introduction
	8.2 What is therapeutic alliance?
	8.3 Applying therapeutic alliance to DMHIs: digital therapeutic alliance
	8.4 Defining digital therapeutic alliance
	8.5 Differences in DTA across interventions
	8.6 DTA in supported interventions
	8.7 DTA in unsupported interventions
	8.8 Measurement
	8.9 Impact
	8.10 Improving DTA
	8.11 The future of DTA
	8.12 Future directions and recommendations
	8.13 Conclusions
	References
Chapter 9 Conversational agents on smartphones and the web
	9.1 Introduction
		9.1.1 Definitions
		9.1.2 Advantages of conversational agents
		9.1.3 Disadvantages of conversational agents
		9.1.4 Systematic reviews
	9.2 Conversational agents on the web
		9.2.1 Barriers to use for web-based CAs
		9.2.2 Text-based CA interventions on the web
		9.2.3 ECA-based interventions on the web
	9.3 Conversational agents on smartphones
		9.3.1 Text-based CA interventions on smartphones
		9.3.2 ECA-based interventions on smartphones
	9.4 Safety issues in using conversational agents
	9.5 Future directions
	9.6. Conclusion
	References
Chapter 10 Voice-based conversational agents for sensing and support: Examples from academia and industry
	10.1 Introduction
		10.1.1 VCAs to relieve the healthcare system
		10.1.2 The advantages of voice modality
		10.1.3 VCAs to provide engaging digital health interventions
	10.2 Method
		10.2.1 Included and excluded cases
		10.2.2 Technical implementation
		10.2.3 Sensing and support
		10.2.4 Explorative approach
	10.3 Findings
		10.3.1 Simple active sensing prototypes
		10.3.2 Simple passive sensing research
		10.3.3 Simple passive sensing products
		10.3.4 Simple reactive health support research
		10.3.5 Simple reactive health support products
		10.3.6 Multidimensional health prototypes and products
	10.4 Most prevalent features and trends
		10.4.1 Primary findings
		10.4.2 Reactive support is easier to implement
		10.4.3 Active sensing requires costly regulations compliance and good speech recognition
		10.4.4 Passive sensing requires extensive and rigorous data collection
		10.4.5 Concerns around data and conversation privacy
		10.4.6 Amazon Alexa seems to rule the market
	10.5 Conclusion and outlook
	References
Chapter 11 Design considerations for preparation, optimization, and evaluation of digital therapeutics
	11.1 Introduction
		11.1.1 Overview of chapter
	11.2 A framework for designing and evaluating digital therapeutic interventions
		11.2.1 What do we mean by design?
		11.2.2 The importance of optimization for digital therapeutic design
		11.2.3 A conceptual framework for informing design decisions
	11.3 Design considerations for intervention development
		11.3.1 Phase 1: formative work
		11.3.2 Phase 2: optimizing intervention design and deployment
	11.4 Design considerations for short-term & long-term efficacy, effectiveness, and implementation
	11.5 Discussion and conclusion
	References
Chapter 12 Cultural adaptations of digital therapeutics
	12.1 Introduction
	12.2 Global burden of mental illness and need for cultural adaptation
	12.3 Methods of cultural adaptation
	12.4 Cultural adaptation of digital interventions
	12.5 Recommendations for applying cultural adaptations to digital therapeutics
	12.6 Conclusion
	Acknowledgments
	Declaration of Interest
	References
Chapter 13 Building the digital therapeutic industry: Regulation, evaluation, and implementation
	13.1 A new category of medicine
	13.2 Digital Therapeutics Alliance
	13.3 Industry progression
	13.4 2017^^e2^^80^^932021: Foundation building
		13.4.1 Landscape mapping
		13.4.2 Digital therapeutic definition
		13.4.3 DTx core principles & best practices
		13.4.4 Intended use & mechanism of action
		13.4.5 DTx product categorization
		13.4.6 Regulatory frameworks
		13.4.7 Industry's expanding value
	13.5 2022 & beyond: Equipping decision-makers and end-users
		13.5.1 Harmonized evaluation frameworks
		13.5.2 Global recognition & utilization
		13.5.3 National policy development
		13.5.4 Clinical guideline & practice inclusion
		13.5.5 Personalized therapies
	13.6 Looking ahead
	References
Chapter 14 Potential pitfalls and lessons learned
	14.1 If you build it, we will come, but we may not stay
	14.2 The human element
	14.3 Access does not equal uptake
	14.4 A “lift-and-shift” approach does not work
	14.5 A blended model of treatment is needed
	14.6 Multidimensional, theory-informed implementation models are needed
	14.7 A more responsive research and development cycle is needed
	14.8 Summary
	References
Chapter 15 Privacy and security in digital therapeutics
	15.1 Introduction
	15.2 Background on privacy and security in digital therapeutics
		15.2.1 Digital health ecosystem
		15.2.2 Security and privacy risks in digital mental health
	15.3 Relevant security and privacy regulations
		15.3.1 United States regulations
		15.3.2 European regulations
		15.3.3 Other regulations
	15.4 Addressing privacy and security concerns
		15.4.1 Privacy and/or security evaluation frameworks and tools
		15.4.2 Security and/or privacy evaluation techniques
		15.4.3 Security and/or privacy design practices
		15.4.4 Usability and interaction design
	15.5 Conclusions
	References
Chapter 16 Ethical considerations of digital therapeutics for mental health
	16.1 Introduction
		16.1.1 Setting the context
		16.1.2 What this chapter does … and does not
	16.2 Ethical issues arising from digital therapeutics in mental health
		16.2.1 Issues directly affecting patients using digital therapeutics
		16.2.2 Societal concerns arising from digital therapeutics
		16.2.3 Health care professionals
	16.3 Conclusion
	16.4 Appendix
	Bibliography
Chapter 17 A look forward to digital therapeutics in 2040 and how clinicians and institutions get there
	17.1 Introduction
	17.2 Technology's role in shifting care: market pull from users and the push from artificial intelligence
		17.2.1 People empowered by mobile technologies
		17.2.2 The research and planning enabling the shift
	17.3 A look at how users^^e2^^80^^99 experience of care and clinical workflow will change by 2040
		17.3.1 Overview
		17.3.2 Evolution of the healthcare team
		17.3.3 Interprofessional teamwork
		17.3.4 Technology and active learning
		17.3.5 Workflow practices on the rise
	17.4 Using technology for integrating care
		17.4.1 Technology training \(competencies\) and evaluation
		17.4.2 Digital and cultural literacy
	17.5 System and institutional shifts for 2030^^e2^^80^^932040
		17.5.1 Overview
		17.5.2 Human factors
		17.5.3 Financing, reimbursement, and licensing
		17.5.4 Institutional competencies
	17.6 Discussion
	17.7 Conclusions
	Acknowledgments
	Conflicts of Interest
	References
Index