The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

Abstract

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies -such as smartphone apps, virtual reality, chatbots, and social media -have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions -including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders -as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

Implementation of Therapeutic Virtual Reality Into Psychiatric Care: Clinicians' and Service Managers' Perspectives

“…Indeed, innovations are more easily adopted when their required procedural knowledge is codified and when access to high-quality training and fidelity-based supervision is available ( 43 , 52 ). Clarifying the role of VR within the clinical workflow, the ongoing need for clinical skill (e.g., assessment, psychoeducation, monitoring) in providing access to VR-based interventions, as well as the potential consumer benefits, may also alleviate identified workforce concerns by reinforcing professional values, including altruistic motivations to help patients ( 21 , 47 , 53 ).…”

Virtual Reality Fitness (VRF) for Behavior Management During the COVID-19 Pandemic: A Mediation Analysis Approach

“…Virtual reality allows consumers to receive medical therapies or instruction as actively participating in an elevated, dynamic, and individualized virtual world, rather than as inert spectators. 52 Statistical findings of our study reported that virtual reality fitness has a positive role in behavior and attitude management during the COVID-19 pandemic isolation. Similar results reported in many studies and state that virtual reality exercise has been acknowledged as a new way to encourage strength training and healthy behaviors in recent years.…”

Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial

“…The high prevalence of anxiety “vastly exceeds the capacities of mental health services,” and this gap has only increased over the past several years [ 75 ]. App-based digital therapeutics offer a viable and practical route toward augmenting traditional mental health care and, in some cases, serve as a first-line treatment [ 76 ]. For example, if a patient in a primary care clinic screens positive for anxiety, an evidence-based digital therapeutic such as the one described in this study can be offered as an augmentation to standard medication treatment, or in some cases, it can be offered if a trial of medications has yielded suboptimal results or if a patient is not interested or willing to try a medication as an alternative.…”

“…As integrative care models (eg, embedding psychiatric or psychological services within primary care clinics) gain momentum, one of the primary limitations is the cost and availability of trained therapists. However, because 85% of the US population has a smartphone, digital therapeutics may be able to serve as the mobile component of an integrative care clinic at a low cost, filling in for the lack of physical space and trained mental health clinicians [ 76 ]. In addition, in corporate settings where employers are increasingly aiming to meet the mental health needs of employees, it may be possible to quickly and confidentially deploy evidence-based digital therapeutics to help employees with mild or moderate anxiety.…”