Phil_Thomas comments on Is effective altruism overlooking human happiness and mental health? I argue it is. - Effective Altruism Forum

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Comment author: Phil_Thomas 29 June 2016 09:50:53PM *  5 points [-]

I’m glad to see some discussion of this topic here, I think it could be a pretty effective area for EAs to work. I have a few comments specifically related to electronic delivery of therapy. I’ve been following the area for awhile, although most of what I’ve read is in the context of anxiety and depression treatment so it might not be applicable to interventions focused on general happiness.

cCBT is as effective as in-person CBT for anxiety and depression in the context of a RCT. But when you change over to open access therapies, rates of adherence drop considerably, with estimates of 0.5% and 1% completion in the only two published studies I could find [1,2]. If your server time and ongoing development costs are low enough, though, cCBT could still be a cost effective approach despite poor retention. This assumes that those that fail to complete the training aren’t harmed, but evidence seems to suggest that even partial completion is helpful [1,2]. Note that in study [1], about 15.6% completed 2 or more of the 5 modules, so a larger portion of people at least partially complete the training. I haven’t done a $/DALY estimate, but it would be fairly easy to come up with one with the results from study [1].

One promising approach to improve retention is to offer health coaches, which interact with cCBT users and help them stay on track to completion. This would be more expensive, but could be a middle ground between cCBT and in-person therapy. Ginger.io is one startup using this approach, and I’m excited to see how things go for them. They offer cCBT, health coaches, and psychologists via video conferencing if needed. This approach could make it pretty seamless for those with mental illness to seek help. There are a few clinical trials testing their technology here, but I can’t find any results yet.

For a good overview of some of the other emerging startups in this space, see this article. It’s especially encouraging to see people with very strong academic credentials founding or on the boards of these startups, which suggests there is fairly good scientific support for the approach. If you want to read more of the literature, the faculty profiles at Australia National University e-health group and cbits at Northwestern are good place to start. ANU’s moodGYM has been around since 2001, so it has been tested in a number of RCTs.

How could effective altruists help in this area?

Now that a number of promising cCBT companies exist, their outcomes might be inevitable. But EAs could still help the therapies spread more quickly, fund RCTs to verify or improve effectiveness, or work directly for these research groups/companies. On the regulatory side, each state in the US has different licensing processes for mental health professionals, which prevents them from video conferencing with patients in other states. Relaxing this barrier would be especially helpful for rural patients. Getting a cCBT approved for Medicare/Medicaid in the US would also be a step forward, but I would think that stronger randomized evidence would be needed before that would happen. One interesting side note is that the UK, Australia, Denmark and Sweden found the evidence strong enough to approve cCBT years ago, so maybe the problem is that nobody has lobbied hard enough in the US?

[1] A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website. http://www.jmir.org/2004/4/e46/

[2] Usage and Longitudinal Effectiveness of a Web-Based Self-Help Cognitive Behavioral Therapy Program for Panic Disorder. http://www.jmir.org/2005/1/e7/

[3] The Law of Attrition. http://www.jmir.org/2005/1/e11/

[4] Adherence in Internet Interventions for Anxiety and Depression: Systematic Review. http://www.jmir.org/2009/2/e13/

Comment author: MichaelPlant 30 June 2016 03:25:28PM *  0 points [-]


this is all really helpful. thanks for the links to the other pieces of research and to a couple of eCBT companies I hadn't heard of yet. Also interesting to see that the challenge is substantially behavioural.

I do hope this outcome is inevitable too, and I hope I can speed it along, rather than uselessly duplicating the work of others.

Comment author: Phil_Thomas 30 June 2016 08:27:46PM 1 point [-]

Yeah I think “inevitable” might be an overstatement, but there do seem to be some pretty promising companies in the area of cCBT for depression right now.

I know less about the apps focused on happiness. Their completion rates might be closer to those of open online courses (~7% on average) because the users might be more motivated. I think building a support community around the app could be important, maybe with users coaching each other? Duplication of effort isn’t necessarily a bad thing at this point because a lot of different approaches are needed to find the right combination of technology/content/support.