The Internet has transformed the way we access mental health support. Today, anyone with a computer or smartphone can use digital mental health interventions (DMHI) like Calm for insomnia, PTSD Coach for post-traumatic stress, and Sesame Street’s Breathe, think, do with the sesame for anxious children. Since most people experiencing mental illness do not access with professional help coming from traditional sources such as therapists or psychiatrists, DMHIs’ promise to provide effective and trustworthy support on a global and equitable scale is a big deal.
But before consumer DMHIs can transform access to effective support, they must overcome a pressing problem: Most people don’t want to use them. Our best guess is that 96% of people who download a mental health app will have stopped using it completely 15 days later. The digital mental health field has been trying to tackle this profound engagement problem for years, with little progress. As a result, the surge of enthusiasm and funding for digital mental health in the pandemic era is dry. To move DMHIs toward their promise of global impact, we need a revolution in the design of these tools.
I think DMHIs struggle to engage users due to the lack of creative innovation in their design. Many of today’s most popular DMHIs still carry a striking visual and functional resemblance to the psychotherapy self-help manuals of the 1990s from which they come. The eagerness of DMHI developers to adhere to these traditional intervention strategies has narrowed the horizon of interventions we consider valuable. The field of DMHIs decided too early in its short history, and with insufficient evidence, that current designs are the best we can make.
The DMHI design today represents only a tiny part of what could be possible. The sole mandate of DMHIs is to produce healthy psychological change, something that creative ideas could accomplish in unexpected ways. Instead of repeating existing designs, we should devote more attention and resources to exploring innovative ideas that can produce real design breakthroughs.
To begin our search for new DMHI models, we need to cast a wide net, exploring radically different visions of how technology can support well-being. Without throwing away what we have heard about DMHIs so farwe must strive to be open to approaches that challenge assumptions and broaden the scope of our conceptual thinking.
On one hand, we can seek design leadership from teams with real-world expertise in creating compelling behavior change interventions, ranging from product advertisers to video game designers. Rather than simply creating DMHIs and hoping people will use them, these efforts prioritize appeal and implementation. Some applied researchers are beginning to adopt such approaches. Harvard’s Amanda Yarnell and Northwestern’s Alexandra Psihogios both lead teams collaborating with health-related social media content creators. They help ensure content is accurate and useful, while creators take the lead with their presentation skills and expertise on what motivates their audience.
In addition to working with outside collaborators and building on popular experiences, we might seek out entirely new ideas. For example, my teammates and I Laboratory for evolving mental health let’s lead a participatory mega-study on brief DMHI for depression. Like the others megastudiesours aims to find a range of innovative ideas and rigorously assess their potential for development and dissemination. Following our open call for any intervention that could reduce depression in less than 10 minutes, we received 63 submissions from global teams. Attendees included high school students, doctors, and popular YouTubers. The submissions were equally diverse; one was a spiritual movement practice, another used artificial intelligence to enhance expressive writing, and a third featured a lively meditative walk through a meadow led by cute animals. Soon, we will rigorously evaluate which interventions are most promising for further development and scale-up.
Pursuing innovative DMHI designs will not be a direct path to success. Some promising ideas will fail, but others might prove surprisingly successful. HAS learn Building on these successes and failures, we need field-wide standards for rigorous data collection and open sharing. As a field, we must strive to take an adventurous stance in exploring diverse new ideas, complemented by robust evidence to integrate learnings and ensure the reliability of new DMHIs. My team’s crowdsourced mega-study models this process on a smaller scale: first by searching broadly for new creative designs, then moving to rigorous and rapid evaluation, and finally by disseminating DMHIs and real-world studies .
We also need evaluation to ensure that new DMHIs are not only effective but also safe before reaching the public. New types of DMHI can carry a variety of risksincluding involuntary harm to mental health And privacy issues.
Industry and academic teams have a role to play in shifting focus from the realm of iteration to innovation. Industrial teams can create exciting, user-friendly products, while academic teams have the freedom to challenge current design standards without intense profit pressure. Funders and institutions can also align their goals with discovery, incentivizing DMHI developers and researchers to try new ideas rather than sticking to beaten ground.
My enthusiasm for exploring new interventions runs counter to much of the prevailing wisdom about DMHIs. Many academics, in particular, believe that instead of trying new approaches, we should focus on optimizing and better implementing current solutions. For them, moving from iteration to exploration may seem like an unscientific step back into uncertainty. I understand their skepticism but I disagree. Although major advances in traditional face-to-face therapy are unlikely, I think DMHIs are different. Their technological capabilities – accessibility, confidentiality and flexibility – make truly innovative and rapid-impact interventions possible. Pursuing design innovation is our best bet to advance DMHIs toward breakthroughs in design and a deeper understanding of what works and, perhaps more importantly, what doesn’t. One thing is clear: what we are doing today is not working.
Benjamin Kaveladze is a National Institute of Mental Health T32 Postdoctoral Fellow at the Center for Behavioral Intervention Technologies and the Scalable Mental Health Laboratory at Northwestern University.