'Digital antidepressants' to be rolled out on the NHS as health bosses give eight apps and web-based therapy courses the green light

article in Daily Mail.

• Around 40,000 people could be offered digital tool to combat depression
• Eight 'digitally enabled therapies' have been recommended by health body Nice

https://www.dailymail.co.uk/health/article-11803727/Digital-antidepressants-rolled-NHS.html

 

More money-making for private companies who make apps?

 

Assistance with problems can often do more than chanting Pollyanna phrases.

I recently saw a Canadian Broadcasting Corporation TV program about the high cost of rental housing. And, not only the extraordinarily high costs, but the appalling situations people are living in.

One such person suffering from depression reported being notably improved when his very substandard accommodation finally improved. He was living in a healthier, safer environment with increased social activity.

Reframing problems in life as perfectly fine, or as I see it, spinning one's wheels, just may not be the way to go, when what's needed is positive action.

 

Has any research been done into the correlation between veracity of claims and actual effectiveness vs number of times someone claims and reaches for the term 'evidence-based' in their sales pitch?

 

Indeed, worse than that it is invalidation and what - psychology-wise - people actually often need just from a short-term coping perspective is to be heard and allowed to speak about their situation and for it not to be invalidated and minimised.

So this is more harm on top of the harm by 'reframing' a lot of the time. Which is why you are supposed to check first whether the cause is actually the % of individuals who might have a fine situation and need therapy by treating the actual cause first and separating out the situational. It's very bad to minimise and pretend someone's hell doesn't exist, refuse to acknowledge or discuss it properly as it really is - even if that might work very nicely for everyone else, particularly those whose job it might be to 'not do the things that are causing an unsustainable for human tolerance' or 'make sure these are resolved' etc. because it is like being allowed to choose between doing the dishes or get away with telling your mum the dishes aren't dirty instead of doing the washing up and encouraging that she sees the same, really

EDIT: PS in my day psychology, real actual scientific psychology, would emphasise that the first step for anyone would require looking at the situational - because the majority would be situational, which when fixed might well mean things resolve (and if not then addressing things can actually be useful because you are not gaslighting but getting them out of a habit they no longer need - pointless if you haven't fixed it). Bad housing circumstances was always used as a prime example of this (they might just be utterly miserable and hopeless because they are stuck in unliveable circumstances they can't get out of without health and vice versa can't get health whilst in).

 

When your whole job can be replaced by a simple app, your job is worthless. Not a single valuable job can be replaced with something as simple as this. This is not about AI replacing jobs, there is no AI here. It's a mindless script that can be easily coded by a second year computer science student.

All this shows is how useless this entire ideology and the industry it sprung up are, that you can automate the useless stuff and it results in the same: nothing. It's the same as automating astrology. It's astrology, automated. You can put pseudoscience in a script and all you get is scripted pseudoscience.

This is what it looks like after decades of having given up. The future of medicine clearly goes through the patients leading the way and unblocking the paralysis, the system has failed us all by giving up trying. It's either cutting edge scientific research, or marketing and pseudoscientific mumbo-jumbo.

 

It's also one of the few easy things an app at this stage of development could do perfectly: just invert everything someone says like a pantomime "oh no it isn't"... "oh yes it is" until someone capitulates to whatever it specifically is that the app can't actually understand as it is just words it is inverting apparently 'not existing'

How that is mental health support needs to be questioned on the basis of basic logic. Even if they do try and hide it under a bunch of pretend niceity words and stats claiming people capitulating in a survey is the equivalent to them being 'better' - it's not far off brow-beating someone with a fake smile on your face as far as I'm concerned if done to those in bad situations, just to make them pretend to be OK at the end of it 'because noone likes a grumpy-chops'.

You are correct, not hard to do at all vs the skill of empathy - that's why so many people think they are great at it, and confuse that with 'being clever' (which it isn't)?

 

Totally agree. Ascertain the real situation first. Don't assume. It's probably the best option in many, if not most situations, even emergencies, where checking out the situation is safe first, should be done before getting in there.

 

The actual report - not the Daily Fail's gibberish: Eight digitally enabled therapies to treat depression and anxiety in adults conditionally recommended by NICE

"Eight digital enabled therapies to treat depression and anxiety disorders in adults have been conditionally recommended by NICE in draft guidance issued today (Wednesday 1 March 2023)

A consultation has begun on the decision to conditionally recommend the digital enabled therapies which address depression and anxiety disorders, including PTSD and body dysmorphia. Each of the digital technologies includes the support and involvement of an NHS Talking Therapies clinician and use CBT techniques.

The eight therapies are conditionally recommended while further evidence is generated. They are the 6th and 7th early value assessments to have been undertaken using a new NICE rapid assessment process that seeks to identify promising medical technology for rapid deployment into the NHS. .............

....................... A consultation has now begun on both sets of recommendations. Comments can be submitted via nice.org.uk until Wednesday 15 March 2023."


More at link. My bold.

 

My first thought is given there is no mechanism for recording adverse events associated with non pharmacological treatments in the UK NHS can we end up with the same situation as with GET where a treatment was introduced on the basis of bad research and researcher/clinicians unevidenced beliefs and no understanding that it should have been counter indicated for people who experience PEM. This resulted in a treatment introduced across the whole country that caused real harm for well over a decade, with the NHS having no insight into the problems despite large numbers of dissenting patient voices.

How will harms and adverse events be record, if they are recorded at all?
How will those for whom the interventions should be counter indicated be identified?

 

Totally serious. Evidence sure is being generated. Accidental honesty.

Same approach as with CBT/GET they did with PACE. "We're testing it, but we know that it works so let's use it immediately, once you do that it's impossible to stop". They counted chickens and they didn't even have any eggs. But the promise of chickens is, somehow, good enough because there are zero standards here.

This is a lot like implementing bad legislation, knowing that once things get in motion they become unstoppable, too many people commit to it.

I can't remember which of the LC study this was, but in a paper where they talked about the trial they are doing (doing a paper about doing a paper, now that's publish-and-perish on steroids), they already planned for how it would be implemented, they assume they will be able to generate the evidence they want, and they sure are correct about that.

It's the foot-in-the-door strategy. This is a travelling salesperson strategy. The customer isn't interested, but if they can't close the door, you just can annoying/bore them until they relent. Except with a lot more coercion and a complete power asymmetry.

I don't think there's ever been a less serious group of professionals. Even in annoying scifi movies where they put unnecessary drama, turning what are supposed to be skilled professionals into moody teenagers, the level of professionalism is clearly higher, there is dedication to the overall goals. It's a damn scripted plot device, and it's still more serious than this scripted garbage.

 

The difference between NICE’s conditional approval of these therapies and their rigorous evidence review in pharmaceutical company Janssen’s appeal for the approval of esketamine for depression is truly striking.

For reference: https://www.s4me.info/threads/nice’...ine-for-treatment-resistant-depression.30996/

 

seems to suggest they are of the opinion that non pharmaceutical treatments are entirely benign & not capable of doing harm.

 

Spot on!
This is exactly what they do. The first time I came across this was some years ago when I first began educating myself about ME/CFS. I was reading about another British trial regarding "CFS" that was about to start (forgive me, I can't remember which one it was), and the main investigator was already extolling its success and virtues, before the trial even began. I was shocked beyond belief and amazed that so-called authorities would tolerate such stuff. Where is the oversight? Where are the investigator's ethics? Doesn't anybody else notice this? It was then that I began to realize that things in "CFS" research in certain sectors were not kosher and could not be trusted. It seemed to me that these "scientists" were in it for themselves and not for the good of patients. It's a despicable thing that continues and haunts us to this day.

 

I think the whole psychotherapy BS started as giving difficult patients someone to talk to (not necessarily in a useful or productive manner) so they wouldn't clog up the areas of medicine "real" patients need to access. So, a social tool rather than a medical one. Eventually, governments started to realize that psychologists are an immense money sink so there is a financial incentive to at least partially automate this process with online courses and/or apps.

 

Coincidental that pain relief drugs and antidepressants being withdrawn ?

 

Yes, not that they really are.

Digitalising talking cures currently provided by wetware is an efficiency saving. Pearl-clutching about over-prescribing of opiates and antidepressants is as old as the hills, but inspired by good motives - even if some sufferers from chronic pain are collateral damage. Completely different motives and genesis.

I suppose they meet when talking cures are theoretically infinitely scalable because they are digitised, and therefore make a more plausible replacement for pills, but that’s not really a grand master plan.

 

afaik 'digital therapeutics' don't have to undergo the same process re rcts as other 'treatments':
see my post (on Mahana therapeutics +) here
https://www.s4me.info/threads/proto...der-moss-morris-et-al.7965/page-3#post-186430

 

Agree this is very serious indeed. For a start, why is the following kind of thing not happening with this - a really interesting re-analysis that focuses on whether the answer to certain wording in Qs actually is proof of the claim/what the authors thought it was measuring?

https://www.bps.org.uk/research-dig...sy-it-implant-false-memories-committing-crime

Don't understand how there isn't some oversight left that insists such things need proper independent assessment - including drawing up what the right criteria are for the questionnaire to actually mean an illness at all, or just actually feeling better or worse or being less/more debilitated.

And there is no reason at all they can't pilot this in e.g. 3 counties and e.g. a trained psychologist assessment + special CAB extra funding for person-focused adjustments and support-person in 3 comparable counties (for issues that are appropriate). And for start and finish +1yr follow-ups to compare how people are doing to be by someone utterly independent of the people dragging into being party to choosing to 'buy' or 'sell' either option. eg if GPs/ICBs have signed up to have one to offer to their patients they will be part of wanting to see it has worked because that is how we all are with something.

Particularly for psychology as a proper subject area. But have the diagnoses and definitions of illnesses become so muddied and non-specific at the same time as the sector set-up with different 'players' clinging on for shares and all sorts of political ins and outs that this becomes fraught with backing horses from a funding/commercial/partnerships and so on point of view rather than actual good for the patient treatment?

There must still be some good parts of some scientific psychology departments that haven't been 'BioPsychoSocial'ed' and do see themselves as a task being to audit and watch-over 'treatment' areas. ie parts that aren't making money out of offering their own. But do care about methods. I don't know why the deal isn't that the sector isn't separated by funders to say those institutions that 'produce' treatments ie have conflicts with big contracts (in future, past or present) can't apply for contracts that assess state-of-sector, state-of-conditions and their knowledge, independent comparison of treatments. Even if an individual wasn't conflicted the political pressure would otherwise be surely there from the institution or partnership. Nevermind the 'mark your own homework'. Why is anything getting these huge roll-outs without the 'other' methods area having to sign it off?

There seem to be some common institutions that seem to be behind most of these revolving-door variations-on-themes so there must be many others who haven't gone in both-feet who could re-position to be auditors. The idea the BioPsychoSocial want to give out that you have to be in their niche area and ideology to comment on them is of course just protectionist nonsense.

CBT initially came from 'the other side' [to psychoanalysis/Freud] but has been made non-specific to a delivery-type mode, and confused into being sold as the same thing whatever 'school' and ergo model and mechanisms are actually behind it (and here it just being good mainly is sold on 'it's an app'). Which isn't true. CBT not being about 'the past' but 'the present' when it was a model for example focused on social anxiety or phobia and a short course because someone was effectively tackling facing that, was one of the main reasons it gained such popularity as a mode - ie it was the very issues with psycholanalytic and assuming 'trauma' and 'the past' that caused the swing for it to be 'in-mode' due to avoiding these. I'm still flummoxed how it allowed it's name to then be used for very different models and ideologies and still 'use' that.

And wondering how this can cover the spectrum up to PTSD here. It just seems a risky area from a liability perspective to tackle with AI (I can't think of how you'd instruct the 'higher level concepts' and warnings of what to avoid doing you'd perhaps need, whilst also being able to do anything useful).

The big scandal that I remember that changed the sector for a long time was false memory syndrome where memories were being 'implanted' - and that debate still rages on: https://www.bps.org.uk/psychologist/recovered-and-false-memories

I do find it quite astounding with anything 'trauma' getting touched upon that times might have moved on where there isn't careful analysis of how safely this is being done.

As this and other issues/well-known backfires are taught as key lessons/learning points in order that the subject is supposed to be allowed to oversee such areas with insight and knowledge of where things go awry with factors implicit in any scenario e.g. power differentials, social psychology inc. peer pressures, group psychology, wishful thinking, means to an end, working with 'whole people in whole situations' and not 'sausage machine issues' and so on.

You'd expect these would all be needing to be discussed and accounted for in methods where there could be implicit perceived threats or risks e.g. if a workplace or school 'wanted you to try x' or where those assessing were also doing.