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Can new technologies address old problems in mental health treatment?

Professor Mario Alvarez-Jimenez and his team from the National Centre of Excellence in Youth Mental Health at the University of Melbourne (eOrygen) has developed a series of novel Internet-based support services that integrate online social networking and effective interactive psychological interventions with peer and expert multidisciplinary support to address the unmet needs and limitations of existing mental health services.

Lessons learned from social media

Online interventions for young adults with psychosis and depression are not new. More than 100 randomized clinical trials (RCTs) show that online services, when used in combination with standard interventions, can improve outcomes. However, only 1 in 5 young adults access online support and most users do not continue to use it over the long term.

More than 100 randomized controlled trials show that online services, when used in combination with standard interventions, can improve outcomes

Social media platforms are very good at recruiting selected users by using ‘newsfeed’ sorting algorithms and targeted advertising. In addition, they successfully encourage users to spend more time on screen by providing fun, creative, interactive content, and by creating online friendships and relationships. eOrygen studied these techniques and used them to identify new ways to attract young adults with mental health disorders, encouraging them to use online support over the long term whilst avoiding the negative effects of social media, such as cyberbullying.

Only 1 in 5 young adults access online support and most users do not continue to use it over the long term

Moderated Online Social Therapy (MOST) – a new way of thinking and caring

MOST is an online platform developed by a range of creative, research, clinical, and computational teams working closely with young adults with mental health disorders and their families. It integrates novel methods of psychotherapy, strengths-based approaches, high-concept comics on mindfulness or other useful techniques, peer/expert moderation, and an empowered peer-to-peer online social network.

HORYZONS – more than just another online intervention

Most mental health intervention programs provide limited (<24 month) care; consequently, relapse rates are high

Most mental health intervention programs provide limited (<24 month) care; consequently, relapse rates are high. Based on MOST, HORYZONS is a novel online intervention that provides support beyond 24 months to young adults with first-episode psychosis.

The HORYZONS pilot study (N = 20) found that usage was safe; in other words, it was not associated with the negative effects that other social media has on young adults.1 Improvements were observed in depression scores, and 7/10 patients with reduced depression score used HORYZONS regularly. Overall, 90% of users said they would recommend HORYZONS to others, and 60% reported increased social connectedness.

A 5-year HORYZONS study has recently been completed in 170 people with remitted FEP.2 Preliminary results suggest that usage was safe and that very high usage was observed in 26% of participants, with moderate to high usage in 25%.

REBOUND — preventing MDD relapse online

According to the cognitive model of depression relapse, a relationship exists between low mood, rumination and depressive episodes. The level of rumination increases with each episode of depression and can be exacerbated by social isolation and low social support. REBOUND is an online intervention that uses mindfulness-based cognitive therapy (MBCT) to break this reinforcing cycle and reduce the risk of relapse.

A pilot study conducted in 43 people with major depressive disorder (MDD) found that use of REBOUND was associated with a significant reduction in depression after 3 months, with 45.2% of users in full remission compared to 11.9% at baseline.3 The effects of REBOUND in people with MDD will be further examined in a 4-year RCT (N = 230), planned to start in 2019.

MOMENTUM — reducing risk in ultra-high risk (UHR) patients

Current interventions for UHR patients can reduce rates of transition to psychosis, but have little impact on social functioning deficits. MOMENTUM is designed to increase social functioning in UHR patients using a combination of strengths-based interventions and mindfulness/self-compassion strategies.

A MOMENTUM pilot study conducted in 13 UHR patients reported significant improvements in social functioning and life satisfaction after 3 months, with a trend towards attenuated symptoms, increased self-esteem and reduced perceived stress.4 A 5-year RCT is planned to start in 2019 (N = 220).

YOTES —increasing employment

YOTES uses moderated online social IPS to develop key employment skills and provide targeted career support to young adults with mental health disorders. An ongoing RCT conducted in 150 patients is due to complete in December 2019.

What about families and friends?

Online interventions, such as MERIDIAN5 and ALTITUDE,6 integrate purpose-built online social networking and expert/peer moderation, with evidence-based psychoeducation to reduce stress, improve family dynamics/communication, and reduce social isolation among carers of young adults with mental health disorders. Preliminary studies show high levels of engagement and improved outcomes.

References
  1. Alvarez-Jimenez M, Bendall S, Lederman R, et al. On the HORYZON: moderated online social therapy for long-term recovery in first episode psychosis. Schizophr Res. 2013 Jan;143(1):143-9
  2. Alvarez-Jimenez M, et al. BMJ Open: In press
  3. Rice S, Gleeson J, Davey C, et al. Moderated online social therapy for depression relapse prevention in young people: pilot study of a 'next generation' online intervention. Early Interv Psychiatry. 2018 Aug;12(4):613-625
  4. Alvarez-Jimenez M, Gleeson JF, Bendall S,, et al. Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy. Schizophr Res. 2018. doi: 10.1016/j.schres.2018.07.022
  5. Gleeson J, Lederman R, Koval P, et al. Moderated Online Social Therapy: A Model for Reducing Stress in Carers of Young People Diagnosed with Mental Health Disorders. Front Psychol. 2017 Apr 3;8:485. doi: 10.3389/fpsyg.2017.00485. eCollection 2017
  6. Gleeson J, Lederman R, Herrman H, et al. Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial. Trials. 2017 Jan 17;18(1):27. doi: 10.1186/s13063-016-1775-5
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