A Qualitative Study Exploring the Experience and Value of “Flow” Transcranial Direct Current Stimulation (tDCS) Device and Behaviour Therapy Training Software Application at Home for Symptoms of Depression

Abstract

Background: Flow FL-100 is a self-administered transcranial direct current stimulation (tDCS) device used in combination with a software application delivered well-being behaviour therapy training, which has evidence of effectiveness in treating symptoms of depression. In this study, the combined Flow FL-100 and well-being behaviour therapy training app, an intervention known as "Flow", was offered by a participant's general practitioner (GP) in a United Kingdom (UK) primary care setting to those who experienced depressive symptoms. Participants completed six weeks of use of Flow. This study explored participants' experiences and views on the feasibility, acceptability, useability, and value of Flow. Methods: A qualitative approach was employed, involving in-depth semi-structured interviews. Thematic and content analyses were applied. Out of a sample of 47 participants using Flow, 18 participants consented to be interviewed. The age range of the participants was 23 -75 years (M = 52.78, SD = 16.27); 10 (55.6%) were female and 8 (44.4%) male. Results: There was support for the feasibility, acceptability, useability and value of combined Flow FL-100 and well-being behaviour therapy training. Most participants described a positive impact on depressive symptoms, sleep, and functioning. Findings provide support for the approach of delivering together both tDCS and evidence-backed well-being behaviour therapy training. Conclusion: Flow has been successfully integrated into a primary care service depression treatment.

A Qualitative Study Exploring the Experience and Value of Flow Transcranial Direct Current Stimulation (tDCS) and Behaviour Therapy Training Software Used at Home for Community Mental Health Team (CMHT) Patients with Symptoms of Depression

“…The physical sensations reported aligned with those listed by Chhabra et al (2020). The findings add to and align with previous evidence of acceptability and uncomfortable but temporary sensations and side effects reported by other qualitative tDCS studies (Gordon et al, 2021;Grycuk et al, 2021;Rimmer et al, 2022;Griffiths et al, 2023), these did not prevent the use of Flow FL100. RCTs show the effectiveness of Flow on valid and reliable measures of depression (Mutz et al, 2018(Mutz et al, , 2019Moffa et al, 2020;Razza et al, 2020).…”

“…These factors translated into reported improvements in functioning such as socialising, having more energy to do activities, undertaking physical activities, and engaging in and enjoying activities; and this generated "a positive feedback loop"-further reducing depressive symptoms. This aligns with improved motivation to do activities reported by other qualitative tDCS studies (Gordon et al, 2021;Grycuk et al, 2021, Griffiths et al, 2023, and with the process of mental health recovery (Leamy et al, 2011).…”

“…Many participants in this study reported improved depressive symptoms. The findings support evidence of perceived helpfulness of tDCS for improving depressive symptoms (Woodham et al, 2022;Griffiths et al, 2023). In this study there were reported improvements in mood, motivation, and sleep attributed to use of Flow.…”

“…Patients in CMHTs typically have severe mental illness and more than one a mental illness diagnosis, and they may need other treatments at the same time as (Sobral et al, 2022;Woodham et al, 2022;Rimmer et al, 2022;Griffiths et al, 2023). Some participants did not use the training modules; autism, ADHD, and unwillingness to try prevented use.…”

“…At 6 weeks and 6 months 30% found it "quite helpful"; at 6 weeks 40% found it "very helpful"; at 6 months 50% found it "very helpful"; and all participants reported it had been helpful to some extent (Woodham et al, 2022). Qualitative studies undertaken specifically on experience of Flow tDCS found most patients reported that Flow improved depression symptoms and is acceptable, and patients would recommend it to others (Rimmer et al, 2022, Griffiths et al, 2023.…”