How Successful Digital Intervention Can Be in Mental Health?

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology, with me, Tjasa Zajc.

[00:00:21] If social media and smartphones are the root cause of the new mental health epidemic in the younger generations, how successful can we be with digital interventions to address these issues?

[00:00:34] In this discussion, recorded at the Digital Health and AI Innovation Summit in Boston in October, I spoke with Catherine Wolf-Laiga, a mental health professional and former college administrator, currently the vice president at BetterMind, to discuss mental health challenges at the moment.

[00:00:56] How are colleges addressing these in young generations? How are we doing with equity and access?

[00:01:05] What's the role of digital, which can be both a cause of higher distress in mental health and a cure for increased access to mental health services? And more.

[00:01:17] Enjoy the show. And if you haven't yet, check out our newsletter, which you can find at FODH.substack.com. That's FODH.substack.com.

[00:01:29] Now let's dive in.

[00:01:52] Kate, thank you so much for taking some time while we're here at the Digital Health and AI Innovation Summit in Boston.

[00:02:02] And since we have some time, we decided to go outside.

[00:02:07] And it's beautiful to be here in front of MIT in nature in a way, which is a perfect setting to talk about mental health.

[00:02:16] You're a mental health specialist by background.

[00:02:19] In the past, for over 10 years, you worked within colleges to take care of the needs related to mental health.

[00:02:26] You're now working with a company that's providing digital health for mental health for younger generations.

[00:02:34] So let's start with a very broad question around what are you observing in terms of the impact that digital interventions can have on mental health,

[00:02:47] given the rising challenge that mental health is?

[00:02:51] Yeah, it's interesting because there are some mixed concerns.

[00:02:56] But what I will say, the benefit in terms of what digital health has been able to support is really the equity and the access for different students.

[00:03:04] So if you have a student out in a rural community, perhaps there aren't enough providers out there.

[00:03:11] And so telehealth has given them the opportunity to connect with a counselor and maybe connect with a counselor who might have a specialist in something that they need that's not available locally for them.

[00:03:23] So there's that piece.

[00:03:24] There's also the piece around the fear for a student to, because it's college mental health typically that I've worked with,

[00:03:32] the fear of a student going into a college counseling center and being seen or that embodied experience being too intimidating for somebody at their first try at a mental health intervention,

[00:03:43] which is really a big piece of how this company was started.

[00:03:46] The founder and CEO of my company, Cody Semrau, was a college student who was fearful about seeking counseling for identity issue he was having.

[00:03:55] And he just didn't feel comfortable going to the college counseling center for a long time until it became desperate.

[00:04:02] And he started this company to support students like him that really just need another option for access to care.

[00:04:08] So in essence, what I hear you saying is that the stigma around seeking help for mental health is quite big.

[00:04:17] And I actually want to reflect on that a little bit.

[00:04:21] When you were working still in colleges in 10 years, what kind of changes did you observe in terms of the needs of students,

[00:04:30] the access that they had to mental health support, and also their own attitude towards seeking that help?

[00:04:39] So there's a couple of stories here, a couple of narratives that I think are relevant.

[00:04:43] One, we've done a really good job destigmatizing.

[00:04:46] We definitely have more people who are help-seeking than ever before, which is a positive thing.

[00:04:51] It's not, for the vast majority, I think, at least a critical mass of students, it's not as intimidating to go as it used to be.

[00:05:00] That said, we see enough persist in terms of some of the ills of our society and that people really do fear the repercussions

[00:05:08] or aren't ready to address something with somebody that feels so intimate.

[00:05:13] And there's this piece that telehealth can kind of support.

[00:05:17] But beyond that, we also do continue to have students who we've made college access a lot more equitable than it used to be.

[00:05:26] So you have students that are coming to college with different challenges than the students before them.

[00:05:32] And partially it's because we've worked to make sure that college in the U.S.

[00:05:38] is more accessible to students who are underprivileged and who are underrepresented in a lot of different ways.

[00:05:43] And the supports haven't caught up on college campuses to support those students.

[00:05:47] So it's, we're recruiting you, we want you here, but we don't have some of the things that are going to specifically support you.

[00:05:53] So then students are interfacing with being, maybe they're at a predominantly white institution

[00:05:58] and they are a black or brown student and are feeling like a major fish out of water situation

[00:06:04] and feeling marginalized and discriminated against or whatever might be going on for them.

[00:06:09] A lot of those students, although it's not inherently, it's not a mental illness,

[00:06:14] the disruption that it impacts them with causes them to go seek support and counseling.

[00:06:19] One of the topics that's raised very often in correlation between mental health and teens or students

[00:06:28] is the use of smartphones, the use of social media.

[00:06:33] From that perspective, what were your observations in that sense?

[00:06:36] Especially in the U.S., there's a big debate going on.

[00:06:40] Campuses and schools prohibiting the use of mobile phones during school

[00:06:46] with different successes, with different measures.

[00:06:48] What are your experiences in that regard?

[00:06:52] As if there weren't enough evidence otherwise, we've seen enough anecdotal evidence to suggest that

[00:06:58] these little computers in our pockets, in some ways, these little slot machines in our pockets

[00:07:03] are getting between us and interpersonal relationships.

[00:07:07] And so people have experienced, for many reasons, of course, but more of a loss of community,

[00:07:12] more of a sense of affinity for each other and attachment to each other,

[00:07:16] meaning that they go get sucked in and use the phone for additional comfort.

[00:07:22] They keep looking for those little hits of dopamine.

[00:07:24] They can't tolerate being bored.

[00:07:26] And I certainly don't want to globalize this to everybody,

[00:07:28] but we do know that we are seeing this at a critical mass in terms of the impact on students.

[00:07:34] Before we had this discussion, you mentioned that when you were still working in a college,

[00:07:40] that you also had some prohibitions in terms of the use of mobile phones.

[00:07:45] Can you talk a little bit about that?

[00:07:46] How did the school decide to not ban phones, but limit their use?

[00:07:52] And how did that whole process look like?

[00:07:55] Because this is still a polarizing issue.

[00:07:57] There's mass shootings going on.

[00:07:59] Parents want to get access to their kids at any moment.

[00:08:03] At the same time, when it comes to bullying, some people say that then if bullying happens,

[00:08:09] it's recorded.

[00:08:10] So you have evidence which helps with potential prosecutions or conflict resolution.

[00:08:15] How did the situation look like in your specific institution?

[00:08:20] And what was the impact after that ban was implemented?

[00:08:25] So actually, it wasn't at my institution.

[00:08:26] It was in my children's high school.

[00:08:29] So they are in their second year of phone ban.

[00:08:33] And the administration and the teachers are reporting it's making a significant difference.

[00:08:36] The students are talking more in the hallways.

[00:08:39] They are more engaged in the classroom.

[00:08:41] And they are, I think they're a little bit more present.

[00:08:44] They're not escaped into their devices.

[00:08:47] Certainly, bullying persists in some of those things.

[00:08:50] But I think they're experiencing some reprieve from it at this point.

[00:08:54] Just being able to teach again and not have everyone completely disengaged from the experience

[00:08:59] of being in high school together.

[00:09:01] Even in the cafeteria, kids talking is pretty critical.

[00:09:05] And being able to have some of those normative experiences in interpersonal relationships.

[00:09:10] A social psychologist, Jonathan Haidt, recently published a book called The Anxious Generation.

[00:09:17] It talks about the impact of social media on teens, especially, for example, young girls

[00:09:24] are very affected by looking at beauty standards that they see on social media, specifically Instagram.

[00:09:30] One thing that's very interesting that he mentions is that some sort of echo that happens in the population

[00:09:38] when, for example, one person is feeling depressed and that kind of spreads like when you're yawning

[00:09:46] and everybody else starts to do that.

[00:09:48] It's not a direct comparison, but there is an impact on that and also an impact of actual patients reporting

[00:09:57] on their mental health or physical illnesses and then others identifying with that and seeking care.

[00:10:04] So there's a lot of things that are overlapping then.

[00:10:08] His suggestion and not just his many psychologists advise that the limit for smartphones should be 14 years old

[00:10:17] and social media 16 years old.

[00:10:20] So what I'm wondering here is how do you see these kinds of recommendations

[00:10:25] and the relationship between digital interventions and what can benefit mental health?

[00:10:32] Like why would digital interventions help if they're a cause of the problem?

[00:10:37] So how can they be a cause and help at the same time?

[00:10:40] The reality is that these things are designed to keep you engaged.

[00:10:44] And so the digital applications that these kids are engaged with are the sole purpose is to keep their eyeballs on it

[00:10:53] as frequently as possible because that's what you monetize essentially.

[00:10:57] And so I think when it comes to digital intervention for mental health related concerns,

[00:11:03] really being able to have applications that are minimal and sufficient.

[00:11:07] So the idea is that, yes, we do understand that there are benefits.

[00:11:11] We understand that the benefits of teletherapy as compared to in-person therapy are pretty equivalent.

[00:11:20] And the pandemic gave us the opportunity to learn more about that.

[00:11:23] But it doesn't mean that somebody needs to spend more time in the application minutes

[00:11:27] that they're connecting to their therapist through

[00:11:29] or constantly using some sort of well-being application on their phone.

[00:11:35] The idea is get in, get out, get the need met and get back out

[00:11:39] and not continue to really exploit what we understand is happening

[00:11:45] with what keeps students, keeps kids engaged in these types of apps.

[00:11:50] Technology is always changing the society.

[00:11:54] What I'm trying to be also mindful of when I'm thinking about what's good and what's bad

[00:11:59] is that younger generations think differently than we think they were brought up in a different world,

[00:12:08] that we were to each extent our interventions that are trying to move children back

[00:12:14] to only the real world, if I call it like that, realistic.

[00:12:21] And to which extent do we need to somehow find the middle way

[00:12:25] where we teach kids how to use technology responsibly?

[00:12:30] Are they even in a developmental stage that they're capable of that?

[00:12:35] As a mental health specialist, I'm assuming that you can talk a little bit about that.

[00:12:40] A little bit. It's not my area of specialty,

[00:12:41] but what I will say is that, yes, we do know that we're seeing a delayed development

[00:12:46] of the prefrontal cortex.

[00:12:48] And so I know that there had been actually, and I think in Jonathan Haidt's work,

[00:12:52] he does reference the Japanese study, and I had heard it come up somewhere else,

[00:12:56] that when they did, I think, functional MRIs of young men,

[00:13:02] that they were finding that prefrontal cortex that they used to identify

[00:13:05] as being maybe fully developed by about 21 is now looking more like 25 or a little bit later.

[00:13:12] And then they're starting to see the trend affect young girls the same way.

[00:13:16] And so the brain development is actually further delayed.

[00:13:19] And I think a lot of that does have to do with how our society has treated safety

[00:13:24] and parenting these days.

[00:13:27] So there's probably a mix of causes for it.

[00:13:31] But this idea that you don't necessarily have the capacity

[00:13:36] to make conscious decisions that are more focused on longer-term impacts,

[00:13:44] you're in the immediate.

[00:13:45] You're experiencing for the moment.

[00:13:48] You're seeking that little dopamine hit.

[00:13:50] You don't really have the capacity to pump those brakes and understand that

[00:13:54] you might not want to make that decision of picking up your phone every time you feel bored.

[00:13:59] Where do you see that most successful interventions are

[00:14:04] when it comes to improving mental health, given your work in this space?

[00:14:10] For example, at the conference, we also saw ideas about creating biomarkers

[00:14:15] where you could detect depression through just a very short discussion

[00:14:19] through voice biomarkers.

[00:14:21] But at the same time, we already have PHQ and GAD criteria

[00:14:27] that help clinicians identify when patients are depressed.

[00:14:32] And just medicalizing people with depression is not enough.

[00:14:38] It has to be coupled with therapy, with other interventions.

[00:14:41] I guess this is also where DTX comes in, meditation,

[00:14:44] and all the other interventions.

[00:14:46] But what I'm thinking is, do we make sure that we are making the best use

[00:14:54] of all the tools that we have and not just exacerbating the problem

[00:14:59] by just over-treating people and giving them proper support?

[00:15:06] One of the things that I like is being able to focus,

[00:15:10] certainly at a population level, on attending to the loneliness.

[00:15:14] Loneliness and the disconnection and the loss of community.

[00:15:17] I think that is one thing that certainly people are attending to,

[00:15:23] but we don't yet know how to make meaningful use of technology

[00:15:29] to support some of that because the goal is you're not using technology, in fact.

[00:15:34] Initially, I can't recall what it was,

[00:15:37] but there was someone who had worked on something that was really about

[00:15:40] supporting meetups.

[00:15:41] And I wish I could remember what it was.

[00:15:43] Papa Piles is one of the organizations that's trying to connect people

[00:15:48] to be companions for different generational populations.

[00:15:53] Yeah.

[00:15:53] And I actually had a discussion about that last year,

[00:15:56] and what was really interesting to me was that,

[00:15:59] especially in the elderly population,

[00:16:01] where loneliness is especially a problematic theme.

[00:16:05] In U.S. culture, people really value their independence.

[00:16:10] So you might think it would be great to create this whole community

[00:16:14] in the elderly population, put them together in one house

[00:16:18] so they can have a blast, but actually they don't really want that.

[00:16:22] So this is also another problem that we have between

[00:16:26] how is society changing towards individualism and not, yeah,

[00:16:31] it is difficult to adapt to something different that,

[00:16:34] theoretically speaking, we know is better.

[00:16:36] We are talking about psychotherapy.

[00:16:39] We are talking about medicine.

[00:16:40] We are talking about things that have some ethical responsibilities.

[00:16:43] And this idea that just because someone will do it

[00:16:48] or just because somebody likes it

[00:16:50] doesn't necessarily mean there's any efficacy associated with it.

[00:16:54] Thinking about some of the apps that are out there

[00:16:56] that our digital natives, you, are interested in

[00:17:00] that they believe is supporting their well-being,

[00:17:03] a lot of times we're seeing that it's not, in fact,

[00:17:06] supporting their well-being.

[00:17:06] It's, in fact, just supporting them being on their phone more often.

[00:17:09] I think that there are plenty of ethical and thoughtful entrepreneurs out there

[00:17:15] and chief medical officers or whomever they are

[00:17:18] that are really trying to focus on where are their gaps.

[00:17:21] So I know some of the speakers that we talked today,

[00:17:24] heard from today, really talked about the gaps.

[00:17:27] Who are we missing?

[00:17:28] Who are we not seeing?

[00:17:30] And how do we attend to bridging that gap through technology?

[00:17:34] That step I really applaud.

[00:17:35] I think it's really incredibly important

[00:17:37] to be able to identify that.

[00:17:40] But to your point, just because we can do something

[00:17:42] doesn't necessarily mean we should

[00:17:43] and doesn't necessarily mean it helps.

[00:17:45] To make some sense out of everything that we discussed

[00:17:49] because we really unveiled and pointed out too many challenges.

[00:17:53] Based on the experience with over 160 colleges

[00:17:57] that the company that you currently work for is working with,

[00:18:01] what are some of the good practices or good trends that you seek

[00:18:04] that are contributing to improved mental health with technology?

[00:18:09] We are seeing students who are seeking support that might not,

[00:18:15] they just might have gaps to access.

[00:18:17] One of the big things that a lot of colleges will use this for is

[00:18:21] for connecting students,

[00:18:24] they have a very homogenous group of therapists,

[00:18:27] whether it's based on professional discipline

[00:18:28] or therapeutic specialty or identities, racial identity or gender.

[00:18:33] And so we have the opportunity for students to be more likely to buy in

[00:18:38] to working with somebody because we have the ability to recruit

[00:18:41] more diverse therapists.

[00:18:43] So part of it is just going to be about identity

[00:18:46] and students' perception about who's going to be able to support them.

[00:18:49] That's just a reality.

[00:18:51] But the other piece too is really being able to give students

[00:18:55] the opportunity to connect with someone.

[00:19:00] Therapy needs to be more than that.

[00:19:01] That there's an ethical responsibility to have a treatment goal

[00:19:06] and look to ameliorate symptoms of an issue, that type of thing.

[00:19:09] But at the same time, we know loneliness is a root cause

[00:19:13] of a lot of disruption to people.

[00:19:15] And so just being able to take that first step at making that,

[00:19:18] that connection I think has made a big difference for a lot of students.

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