The online psychologist - Mental Health Awareness Week 2019

For Mental Health Awareness Week 2019, we are exploring how the University of Oxford has been researching the potential of online psychological treatments to support better mental health care.

The effects of the internet revolution over the past decade alone has been astounding. From the palm of our hand, the top of our desks and in our pockets, we have drastically altered the way we conduct our everyday lives and enhanced our capabilities.

The scale of internet use alone is evidence enough of its effects. According to the Office for National Statistics, 90% of adults in the UK reported being regular internet users and virtually all adults aged 16 to 34 reported being recent internet users (99% in 2018 compared to 44% of adults aged over 75).

Internet driven technologies have enhanced most aspects of our everyday existence, but what’s the potential for harnessing this capability for better health and care? We are seeing both national and local policies that are emphasising the need for embracing a spectrum of internet driven technologies to support professionals and patients alike.

But what about mental health? This Mental Health Awareness Week, the scale of the mental health challenge is serving as an urgent reminder as to why we should be embracing innovation in tackling it.

One in four of us at some point will face a mental health problem each year. 300,000 people leave the work place each year because of mental health issues and it accounts for 15.4 million sick days.

It presents one of the most burning social and economic issues facing the world today.

Some of the most common disorders seen by mental health professionals are Social Anxiety Disorder (SAD) and Post Traumatic Stress Disorder (PTSD). SAD normally starts in childhood or adolescence and is one of the most persistent disorders when not treated. PTSD is a common problem that can occur after a traumatic event and can lead to chronic disability and high healthcare costs if left untreated.

Both of these conditions normally respond well to psychological interventions such as cognitive behavioural therapies (CBT). Specific CBT interventions for these problems were developed by researchers at the University of Oxford at the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT). These treatments are now widely used within the NHS and beyond, and are recommended by the National Institute for Health and Care Excellence (NICE).

While CBT can effectively treat these two common conditions, like any medical intervention, it comes with its own unique set of challenges. Common across mental health services, patients can face difficulties in accessing treatment given the high demand and limited number of therapists.

In the light of these problems and the scale of internet use, one potential solution that is receiving attention here at the University of Oxford is the use of internet-based versions of effective psychological therapies that have traditionally been delivered face-to-face.

OxCADAT have been investigating therapist-guided, internet-based forms of their previously developed CBT programmes for SAD and PTSD and assessing their effectiveness and potential.
The early research has shown some promising results.

The clinical outcomes of these early studies have suggested that internet-delivered CBT may be just as effective as face-to-face therapy sessions. Crucially, good outcomes have been achieved with a drastically reduced workload for the therapists compared to face-to-face clinical settings: 20% for SAD and 25% for PTSD treatment.

As well as being less resource intensive, the early results have indicated that patients may find online-delivered therapies just as acceptable as traditional face-to-face therapies. The early pilots have shown that patients reported greater control over their treatment and greater convenience when undertaking therapy online. In patients suffering with common mental health disorders, this has the potential to attract a greater number of people seeking treatment.

Therapy for common mental health disorders going online has the potential to transform and improve the mental health treatment offering. There could be reduced waiting lists, greater successful turnover of patients, more patients being able to access treatment even if they cannot attend face-to-face therapy and a reduction in the societal and economic burden of mental health problems.

What the key focus is now here at Oxford is examining these treatments further and building the evidence base. Oxford has been a world leader in the development of face-to-face psychological therapies, which are now mainstream throughout the NHS. It is hoped that online CBT can reach the same level of success.

Furthermore, there is also ongoing research adapting internet therapies for global use. Online solutions to these conditions could make a big difference to the global mental health crisis, if we can find effective methods to transport and adapt these programmes for use around the world.

Although these are early days, the results are indeed encouraging. If further research is just as promising, Oxford would be building on its proud legacy in leading some of the greatest evolutions in mental health treatment.