Computer Therapy for Depression Shouldn’t Be Ignored: A Response to NPR, the British Medical Journal, and Kaiser Health News

Tweet about this on TwitterShare on Facebook

An article published by NPR on November 12, “Depressed? Look For Help From A Human, Not A Computer,” by Lynne Shallcross of Kaiser Health News (KHN) reported on the REEACT study by recently published in the British Medical Journal. Gilbody et al. (2015) sought to examine the relative efficacy of two computerized guided self-help cognitive behavioral therapy (CBT) programs, Beating the Blues and MoodGYM, against usual care by general practitioners (GP). Lantern’s Chief Science Officer Dr. Megan Jones, along with an international group of researchers at ICare, find parts of the KHN article, as well as the researchers’ analysis in the study, to be speculative, rather than fact-based. Dr. Megan Jones and ICare researchers submitted a research-focused response to the British Medical Journal, “Why didn’t patients use it? Engagement is the real story in Gilbody et al. (2015), not effectiveness.”

Here is the response they submitted to KHN:

The Shallcross article,“Depressed? Look For Help From A Human, Not A Computer,” reveals a widespread misunderstanding of the true lessons from the Gilbody et al. (2015) study, and makes non-factual assumptions in the article that could potentially discourage people from obtaining digital treatments for depression that have been proven to work.

The Gilbody et al. (2015) study has an important story to tell, except it isn’t about effectiveness, it is about engagement and adherence. Gilbody et al. (2015) found that participants who were offered computer-delivered CBT experienced “no additional improvement in depression compared with usual GP care at four months.” Word choice matters a lot here. These participants were “offered” online guided self-help CBT, except that nearly all participants didn’t take it up. In fact, nearly everyone in all three arms of the trial received the same thing – GP care supplemented by a small dose of education (e.g., one session of online CBT).

When the majority of participants only completed one or two modules of computerized CBT, it is quite a leap to conclude that the interventions are “not effective.” In the NPR-published article, Shallcross states that online programs to fight depression are “not effective because depressed patients aren’t likely to engage with them or stick with them.” This statement is an inference and is not backed by evidence.

It isn’t only Shallcross’ interpretation of the findings that is misleading. The authors of the study did not focus their analysis on exploring predictors of adherence to computerized CBT, or include sensitivity analyses addressing interactions between adherence and outcome– key questions that could help advance the research in this field. Neglecting to measure adherence in self-help intervention trials will compromise the interpretation of research findings, and, in turn, can lead to inappropriate decisions regarding the implementation of such interventions. If a program is found to be non-effective while participants are not exposing themselves to a sufficient “dose” of it, further research must be undertaken to investigate augmenting components to improve adherence (e.g., regular prompts or additional personal support) instead of discarding the idea of self-help altogether. It is vital to study both intervention effects of and adherence to self-help interventions simultaneously and, in the opinion of some researchers, scientific malpractice not to do so.

The real issue in this study is the way the treatments were presented to participants. It would be important to understand how GPs described the online CBT programs and how they encouraged patients to use it. Context matters most in such implementations.

The research methods used by Gilbody et al. were not appropriate to determine if online CBT “worked” or “didn’t work”.

If the main finding of the study around lack of additional improvement from computerized CBT proves anything at all, it is that when people have access to high-quality GP care for depression, that might be all that they need. The problem is that most people don’t have access to regular GP care or have to wait a long time to access it. The KHN article, in it’s abstraction of the facts, also misses addressing the promise of digital treatments, which surely would have been noted if Shallcross had interviewed a digital health expert for this article.

A limited number of people who need mental health treatment actually get it or utilize it. Computerized CBT for depression offers a more accessible and affordable option for people that do not have access to GP care.

Digital programs also help people avoid other barriers to care, such as stigma. Therefore, computerized CBT programs are a critical tool for expanding treatment to more people, because they may be the only care they can receive.

KHN’s article reveals a larger flaw in accurately investigating the evidence behind digital mental health technology by using language that implies smoke and mirrors, rather than a field that is based in strong scientific research. Like most healthcare services, not all online or digital programs are created, or implemented, equally. Therefore, all digital programs should not be dismissed based on assumptions.

Signed by:

Megan Jones, Lantern, San Francisco, United States and Stanford University School of Medicine, Stanford, United States

Rosa Baños, Universidad de Valencia, Spain

Ina Beintner, Technische Universität Dresden, Dresden, Germany

Thomas Berger, Universität Bern, Switzerland

Cristina Botella, Universitat Jaume I, Spain

David Daniel Ebert, Friedrich-Alexander University Erlangen-Nuremberg, Nuremberg, Germany

Dennis Görlich, Westfälische Wilhelms-Universität Münster, Germany

Corinna Jacobi, Technische Universität Dresden, Dresden, Germany

Heleen Riper, VU University Amsterdam, Amsterdam, The Netherlands

Michael P. Schaub, Swiss Research Institute for Public Health and Addiction, WHO Collaborating Center, University of Zurich, Zurich, Switzerland

Ulrike Schmidt, Kings College London, United Kingdom

On Behalf of the ICare Investigators

How to Navigate Etiquette (Or Lack Of Any) in the Digital Age to Avoid Social Anxiety

Tweet about this on TwitterShare on Facebook

I once had a friend who didn’t text me back for three months. And this isn’t a “ghost” story—one where she disappeared forever, without any explanation. She’s actually still my friend.

Over the course of those three months, I invited her to join me for several outings—with no reply. At first, I assumed her silence was innocent enough. But then one week of silence became two, then six, then twelve.

Around week eight, I concluded that I must have done something terribly offensive to deserve this shocking rejection. Nothing negative had happened the last time we’d hung out to cause a rift. We hadn’t argued, or had a lackluster time together that proved our friendship had faded. We ate, we hugged, and we promised to hang again soon.

And yet, twelve weeks later there was still a booming silence. I was confused and upset, and tried to accept that our relationship was suddenly over—without explanation. I had been ghosted.

Then twelve weeks and two days into the great silence, which had filled me with worry about my actions as a friend—she emailed me. Her email didn’t mention any of the reasons my anxiety-fueled thoughts had credited to her silence. It detailed in length how she was sorry for being unavailable, explaining that a work project had eaten up all of her free time. She was dying to get together as soon as possible. Her email implied—against all my emotional reasoning—that nothing was wrong all along.

It was a relief to know my friend’s absence had nothing to do with me. And it also wasn’t. From that day on, I never stopped wondering: was I the one being rude or was she?

Are We Giving Ourselves Anxiety by Abandoning the Basics of Social Etiquette?

When I was growing up, I had been taught some simple social graces. They weren’t unbendable rules of etiquette, but more like expectation guidelines. I adopted them as basic standards of how to treat people in social settings and relationships.

In our contemporary, text-dominated times, one of the social graces I learned as a child sticks in my memory. It was this: if a friend reached out two or three times, then it was my turn to initiate contact the next time if I wanted the friendship to continue.

As my mom put it, “You can’t always expect her to do the inviting. Inviting is a risk. You have to take on some risk too.”

Now that I’m an adult and a relationship coach, I’ve noticed that this particular guideline seems to have been erased from our collective consciousness. That’s not to say that guidelines around what’s “polite” and “rude” can’t change (I will put my elbows all over this table, thank you). But when a rule around what’s expected in relationships seems to disappear, doesn’t its absence make relationships much harder to maintain?

Doesn’t a lack of any standard social graces make relationships more stressful than they need to be?

For example, that interesting yet profoundly anxiety-producing time with my apparently-not-former friend. Was she being rude for ignoring me? Or, against my better judgment, had I been rude for messaging her insistently? Was I hounding her or was she ghosting me?

3 Ways to Reduce Relationship Anxiety Around Social Etiquette 

Collectively, I think we’re all confused about what we’re “allowed” to expect of one another. And I see a connection between this lack of social norms and our growing sense of anxiety around relationships.

In my own life, I’ve found that the best way to counteract this anxiety is to consciously build some “expectation guidelines” back into my relationships. Below are three tips I’ve developed for communicating expectations in relationships and, by extension, reducing relationship anxiety.

Explore expectations on a smaller scale.

While most people no longer grow up with standard social expectation guidelines, that doesn’t mean you can’t discuss individual expectations on a smaller scale.

For example, when you make a new friend or embark on a new romance, ask them what they consider normal when it comes to digital communication. Does he find it weird if someone doesn’t text him right back? Does she mostly ignore voicemails but always responds to texts?

These types of conversations will lead to greater understanding of your friends’ particular expectations, and by extension, what you can expect of them in return.

Move the interaction off-line

Truth be told, much of the anxiety people experience around relationships these days is because we communicate primarily through digital devices. While phones are incredibly useful for keeping in contact, they remove many layers of communication, such as voice, tone, and body language, that help us understand the meaning behind the message.

That means texting breeds misunderstanding, and misunderstanding breeds anxiety

If you’re feeling anxious about how or when someone is responding—or isn’t responding—to your texts, your best bet is to take the conversation off-line. Often, ten minutes of in-person discussion will give you more clarity about what another person is thinking and feeling than 100 texts will.

Accept vague endings

One of the most anxiety-provoking aspects of our etiquette-deficient culture is the ever-present possibility that our relationships can end for reasons we never fully understand.

Before smartphones became prevalent, it was considered extremely rude to end a relationship, even a friendship, without giving a reason and providing some closure. Today, many people are less inclined to have tough conversations, preferring to avoid them by ghosting instead.

While I was coming to terms with the disappearance of my not-former friend, I realized that if somebody is truly unwilling to engage with you, you’ll get more peace from trying to accept the ending, however vague it may be—than from trying to re-engage them.

I liken this type of acceptance to forgiveness. By accepting the end of the relationship, you’re not condoning how they ended it. You’re not saying what they did was right. You’re simply asserting that your own emotional well-being is your top priority, and, through acceptance, you choose to preserve it.

To learn how to cope with social anxiety or stressful social situations, try a free 7-day trial of Lantern here. You’ll be paired with a professional coach that can guide you through anxiety-reducing techniques, and listen and give you feedback on your specific relationship concerns.

Lantern launches stress program to teach people how to manage stress, provide support

Tweet about this on TwitterShare on Facebook

Stress track app

Today, Lantern announced the release of our stress track, designed to give individuals affordable access to skills and support to manage stress in healthy, effective ways. The stress track is the third emotional health track Lantern has developed to date, and will help people reach their potential in many facets of their lives. Lantern also offers an anxiety track to help users lessen their anxiety, and the body program, designed to improve body image and reduce disordered eating behaviors.

Like our anxiety and body tracks, the stress track is based on Cognitive Behavioral Therapy (CBT), a psychological approach that focuses on empowering individuals with the practical tools they need to feel better. We also pair each user with a one-on-one coach who helps them set goals and stay accountable. Our coaches are experienced behavior change professionals trained in CBT.

CBT has been proven time and time again to reduce stress, anxiety, and mood disorders. So, if a proven approach exists and Americans are aware of their unhealthy stress levels, why aren’t more people seeking it out? Because most CBT resources aren’t convenient.

Whether it’s hard to schedule time off of work or you live far away from a therapist’s office, time constraints and transportation issues are common reasons people don’t get the emotional help they need and desire. Cost of care and the stigma surrounding mental health issues are also huge barriers to in-person therapy.

Lantern has solved this care-delivery problem with a combination of engaging CBT exercises and personalized coaching—offered at a fraction of the cost of in-person therapy.

Since Lantern is available on smartphones and the web, users can do their Lantern exercises at their own pace, wherever they want. Our model drives incredible engagement: 60% of users who complete their first three sessions finish the entire 40 sessions in their program.

We’ve proven our combination of online CBT and coaching works. Users who complete their Lantern track report a 40% reduction in anxiety and stress symptoms, on average.

Lantern’s new stress track empowers individuals with lifelong stress management skills

Stress has a shocking impact on people’s health and happiness. In the U.S., three out of four visits to the doctor are due to stress-related health problems. Americans know that they’re all too familiar with stress: on average, they rate their stress level as higher than what they believe to be a healthy level.

Many people don’t know what stress actually is. Stressed-out people often feel overwhelmed by their to-do list, pressure from their boss, or other people’s demands on their time. But stress isn’t external. Stress is how someone responds to life’s stressors—and it’s something people can learn to control with CBT and support.

CBT examines the relationships between thoughts, feelings and behaviors. Some people exercise or binge-watch TV for temporary stress relief, but these only act as a bandaid for the problem. Real change happens when people learn how to manage the thoughts, feelings, and behaviors that stress triggers.

The stress track is a personalized experience that will help users understand stress triggers and responses, teach tools to address behaviors in order to stop the stress cycle, and apply new skills across different domains of life: work, family, and self-confidence.

The stress track includes:

  • 40 quick sessions that users can access wherever and whenever through the web or a mobile app
  • Exercises and podcasts that teach the foundations of CBT
  • Interactive techniques that train users in how to build constructive habits that prevent procrastination, multi-tasking, and burnout
  • Unlimited messaging with a one-on-one coach who gives feedback and helps individuals set goals and stay accountable for reaching milestones

If your stress is getting in the way of your relationships, career, or self-confidence, start your 7 day free trial now. Just click “Customize Your Plan.”

Helicopter parenting makes you miserable: 3 ways to reclaim your life to benefit the whole family

Tweet about this on TwitterShare on Facebook

There are so many modern parenting guides for raising successful (and intelligent, moral, creative, vegan, eco-friendly, bilingual, and musical) children, that trying to navigate the child-care section at the bookstore—let alone parenting itself—can be confusing.

The sheer number of parenting books highlights our concern for our kids’ well-being. But our well-intentioned desire to shape our children’s future has developed into major anxiety about their safety, happiness, and ability to succeed. This anxiety is the heart of over-parenting, or helicopter parenting.

Many of us second guess every move we make as parents. Since “parenting” wasn’t even used as a verb until the 1970s, there’s not a clear script for effective parenting. So today’s parents are trying to piece together a job description from scratch, while also preparing their kids for an increasingly competitive world.

But the more we anxiously try to make sure our kids become thriving adults, the more we’re communicating anxiety and passing it down to them. That means our obsession with doing everything right actually has the opposite effect on kids than we intend. Children of helicopter parents are more anxious, depressed, and emotionally dependent on their parents than kids that aren’t coddled.

But, perhaps ironically, much of the analysis on the negative effects of helicopter parenting focuses on the children. What about the parents? The fact is that helicopter parenting is detrimental to us, too. Here’s how over-parenting makes you miserable, and ways to take back your life to the benefit of your whole family.

3 Ways Being a Helicopter Parent is Bad for You

Helicopter parenting makes you 1) depressed, 2) stressed, and 3) unhappy. A 2012 report in the Journal Of Child And Family Studies found that mothers with an “intensive parenting attitude” were more stressed and depressed than mothers who were more laissez faire. Keep in mind that laissez faire doesn’t mean not caring and not keeping kids safe, healthy and happy.

The study also found that mothers who believe parenting is “difficult” or that parents’ lives should revolve around their children also reported less satisfaction with their own lives.

And since studies show mothers spend more time with their kids than they did in 1965, when women largely weren’t in the workforce—your intense parenting schedule is probably leaving you exhausted, too. While mothers still tend to spend more time with their children than fathers, a helicopter parenting-attitude would likely have similar emotional effects for men.


How did we end up here? The connection between anxiety and over-parenting

Ours fears generate anxiety. Because we want to protect our children from harm and ugliness in the world, we project our worst fears onto them. But “over time, parents can become hypervigilant for any signs of trouble in an attempt to cut it off at the pass,” Kara Fitzpatrick, a clinical psychologist and expert in adolescent health at Stanford University, explains.

“In general, when we’re anxious, we try to avoid strong negative emotions, like disappointment and upset. As a result, our anxiety can cause us to work hard to make certain our children never experience those negative emotions. Of course, this ignores the fact that everyone experiences upsetting feelings, and that they’re an opportunity to learn emotional resilience,” Fitzpatrick says.

Many helicopter parents try to protect their children from disappointment and struggle by setting them up for college and career success. Remember the craze around Tiger Moms? The book struck a nerve among many parents suggesting their fear was true: that they weren’t doing enough to make their kids successful.

But as shuffling kids to multiple extra-curriculars and doing homework over dinner becomes the new norm, we’re diverting more of our resources from ourselves and pouring them into our kids. And it’s not to the parents’ or children’s benefit.

Fitzpatrick argues that over-planning for the hard skills children will need in the future is futile. “In my generation, parents wanted their children to be stockbrokers, lawyers and doctors. Parents of today want their children to be engineers. We can’t tell what the skills of tomorrow are. Instead we should focus on developing adaptive, creative, resilient children who can meet the demands of their future.”

3 ways to take back your life (for your whole family’s sake)

Make time for relationships with friends or your partner.

Research shows that people with strong relationships are significantly happier, less stressed, and live longer. Feeling connected with people gives us a greater sense of identity and the comforting feeling of belonging to a community. Fostering relationships is important, and science shows they can’t be replaced with small talk at PTA meetings. People with the highest levels of wellbeing have more meaningful conversations, according to a 2010 study in Psychological Science.

Being social will also show your kids what it’s like to be a highly functioning adult. “Children learn about relationships, social problem-solving, and friendship skills from every available source—including parents. Letting your child see the importance of different relationships—with all the messy, funny, tough and touching results—will help them learn how to navigate their own relationships,” Fitzpatrick says.

Seize windows of freedom joyfully, without guilt.

By finding time purely for yourself, you’ll be calmer, happier, and less overwhelmed.  This may mean accepting that not everything on your to-do list needs to get done, which will free up some time for you to schedule solo pursuits.

These could be anything from going to the gym before you drop your kids off at school or reading for thirty minutes without interruption. Instead of just dropping your child off at dance class, connect with your curious and playful side by taking a separate class at the same time. Experiment with different activities to see what makes you feel most rejuvenated or rewarded.

There are also huge parenting benefits. “Taking care of ourselves is of the greatest importance. The way we care for ourselves as parents is a clear message we send to our children. Children deserve to see that a life worth living takes investment in ourselves and our passions. If we pride ourselves only on their successes, we transfer the burden of caring from ourselves to them. They become responsible for our happiness, our success and our value,” Fitzpatrick explains.

Follow your own passions so your kids learn to follow theirs.

Fitzpatrick’s advice: “If you love art, reading, or gardening, take time to pursue those activities. A shared hobby is great for connection, so involve your kid to see if they develop an interest, too. Your child may not learn to love these very things, but they will learn how to take pride in what they do, spend time supporting skills that they value, and that the pursuit of knowledge never stops.”

Building our own emotional resilience is critical for our own happiness and can also help us be calmer, even-tempered parents—parents who can take a step back and let kids develop independence. Letting go of your fears for your children’s safety and success can be difficult. Find the support and anxiety management tools you need by trying Lantern free for 7 days.

Science vs. Snake Oil: How to choose a health app that gets results

Tweet about this on TwitterShare on Facebook

There seems to be a health app for everything. Sleep better, train for a marathon, stick to your medication schedule–there’s nothing you can’t do when you’ve got a smartphone. But with more than 100,000 health and wellness apps available in the iTunes and Google Play stores, the options can be paralyzing. And even if you do hit download, many health apps simply don’t work.

The best digital health products empower individuals to take control of their health. Just like you care about your doctor’s trustworthy reputation and high-caliber training, educated digital health consumers apply these same standards of quality to health apps.

Why Not Doing Your Homework on Health Apps is Risky

Just because an app is available doesn’t mean it’s reliable. There’s a low threshold to creating an app and selling it in an app store. The FDA only regulates health apps that provide analysis, diagnosis, treatment, or treatment recommendations—only about 100 of the 100,000 apps on the market. App stores accept all other health apps without FDA evaluation.

Consumers are expected to download mobile healthcare and medical apps over 142 million times in 2016. As the wellness industry explodes, companies are capitalizing on this unregulated opportunity.

Many app developers build health apps quickly—basing apps on bogus science (like these apps that claimed cell phone lights could cure acne) and without conducting studies on the app’s effectiveness.

If an app’s not giving you real results, it’ll be a waste of time and a drain on your motivation. But it’s not just that—an unreliable app can also put your health at risk. For example, a health app that provides incorrect diagnosis could cause undue anxiety and worry about a health condition – or worse yet, a missed opportunity to seek needed treatment early.

In the Wild West of digital health, how do you choose an app that will actually help you meet your goals? Here’s what you need to know to evaluate whether an app will get the job done, or whether it’s just snake oil.

1) Who made the app and who’s profiting from it?

Spend some time researching the maker of your product. Is the app made by a large corporate organization? If so, they may have an incentive to encourage you to buy more of their products. Did someone with a dubious medical or research background make it? It may be more snake oil than science.

If you’ve done your research and still aren’t sure what to choose, check out a list of legitimate apps, curated by health insurance and digital health companies. For example, Cigna gives its customers access to an Apps & Activities page that recommends apps and allows a customer to track their activity on various apps all in one place (Cigna). HealthTap, a telehealth startup, runs an initiative called AppRx that asks doctors to recommend health apps to the public. You can find their best recommendations in an annual HealthTap report.

If a company or app claims to be endorsed by another company (often with a logo on an About Us page), make sure the company providing the alleged support reflects the same endorsement on their website.

2) Is the app based on good science?

Scientifically tested digital health apps are the minority, since most health apps are legally required to undergo a rigorous clinical research process. But there are companies committed to creating effective, science-based solutions for consumers. When evaluating an app, you’ll need to figure out whether the company can backup their marketing claims. Look on the creator’s website for:

A section on research, complete with citations or links out to original research papers. Lumosity currently advertises that they “transform science into delightful games.” To support this claim, they have a detailed science page that clarifies how their games relate to their original psychological research (see below). On Lantern’s website, you’d find links to original and outside research that shows we base our program and coaching model on best practices in Cognitive Behavioral Therapy.

A team member or advisor whose clear responsibility it is to uphold the scientific integrity of the product or service. At Lantern, that person is me—the Chief Science Officer. My job is to make sure our company delivers a product that has high effectiveness (meaning, results that match or beat what is reported in research studies – and has meaningful results in “real life”) and protects safety and wellbeing of our users.  Other titles to look for include “Chief Medical Officer or Medical Director”

Sample size, clear metrics, and explanations attached to any presentation of data. Here’s an example from Lantern:

3) Safety, security, and privacy: What data is collected, and what is done with it?

Digital health companies will gather data on you. Some companies will use data for good things like making your experience better or supporting medical research. Some may violate your privacy by selling your data to advertisers or other business partners. Before downloading a health app, read a company’s Terms of Use and Privacy statements to find out:

  • The kinds of personally identifiable information (PII), like your name or address, that’s collected, and with whom it’s shared
  • The process for viewing or requesting changes to that PII
  • The process by which the Terms of Use or Privacy statements may change, and how you’d be notified of changes

Ideally, if based in the U.S., a health app will state its compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was created to protect and secure your personal health information.

As an informed consumer, you’ll be able to make a healthy and effective choice next time you pick out a health or wellness app. Remember that companies, especially those still in startup mode, want your business. So they’ll likely respond to you if you reach out with questions. Don’t be afraid to contact digital health companies to clarify their offering, business model, or data privacy and security protocol. Your questions will also help the company identify weaknesses and build a better product.

Have you downloaded any health apps that work for you? Do you know if they’re backed by science? Let us know in the comments.