Jenna Sauber, a Washington, D.C. resident, has tried both online and traditional therapy.
For years, Jenna Sauber took advantage of traditional therapy, setting an appointment with a mental health professional to help her through various life and relationship issues.
"The traditional model of therapy suffers from access barriers that keep enormous numbers of people from getting the care they need."
But when Sauber, 33, needed help extricating herself from a friendship that was becoming toxic, she tried another route of therapy. Life was getting busy for the communications professional from Washington D.C., and Sauber decided it was time to try something new – signing up for an online therapy smartphone app.
She isn't the only one trying therapy on-the-go. The online mental health industry has been booming in recent years, and technology companies – even giants such as Apple and Google – are sensing an opportunity to serve a market that wants to tend to their mental health wherever they are. Some are even tapping virtual reality used with a smartphone to help fight alcohol and nicotine addiction.
For those seeking a sympathetic ear – or text – companies such as Woebot offer a mental health chatbot to help patients relieve their anxiety or depression. Other companies, like Better Help and Talkspace, provide licensed mental health professionals who are available to connect with a patient throughout the day.
Recently, Olympic swimmer Michael Phelps became a brand ambassador for Talkspace after he disclosed his own struggle with depression.
Since Talkspace launched in 2012 by two psychologists, the company says it has worked with more than one million people seeking help.
How It Works
Potential clients fill out a questionnaire, detailing their mental health needs, and are connected with a professional whose specialties align with those needs. Basic text messaging packages are often offered by online therapy companies, as well as live-conversation packages and couples therapy. The average cost of these packages can vary and is usually billed weekly, with the ability to discontinue at any time.
Dr. Neil Lieberman, the Chief Medical Officer of Talkspace, is a board-certified psychiatrist. His background includes the oversight of inmates with severe psychological issues. One of the biggest advantages of online therapy, he says, is its accessibility. More than 70 percent of Talkspace users have never before been in therapy.
"It's a promising, but largely untested way to receive care."
"The traditional model of therapy – brick-and-mortar, 45-minute sessions – suffers from access barriers that keep enormous numbers of people from getting the care they need," Dr. Lieberman says. "Talkspace makes it possible for people to enjoy all the benefits of traditional therapy for a fraction of the cost, and without the need to schedule an appointment, travel to an office or get time off work."
Is It Effective?
This industry, while fast-growing, is still young. Psychiatric professionals are still trying to gauge its success, and whether it's providing the support its clients seek.
Dr. Vaile Wright, a licensed psychologist and the director of research and special projects with the American Psychological Association, says there isn't a lot of research available regarding online therapy.
"It's a promising, but largely untested way to receive care," says Wright.
She describes a spectrum of online therapy-type products available to consumers, ranging from meditation apps to videoconferencing services with a live therapist.
"There may be someone who doesn't necessarily need a mental health diagnosis but could use the mindfulness app to really feel more centered. What we generally see and what we think is probably effective is the use of these apps in conjunction or as an adjunct to a face-to-face ongoing relationship."
The APA offers a set of guidelines for professionals and for consumers that highlight issues that potential patients should consider before choosing online therapy, along with research material and other sources for help, depending on the condition.
There are still a lot of unknowns about online therapy, including potential security, confidentiality, privacy laws, and emergency situations, Wright says. "Consumers do need to be aware of that."
Lieberman says that the Talkspace app and website is encrypted to protect information. The company has also been certified as HIPAA compliant, meaning that the company must have a system in place to protect patient information.
"We take privacy, security, and confidentiality very seriously," he says.
For Sauber and her problematic friendship, online therapy was ultimately a let-down.
"She was very nice," Sauber says of her app therapist. "She would check in twice a day, once during the day and then at night. I'd type out what was going on and she would chime in that night or the next morning. It wasn't truly real-time unless you happened to be online with her window. I found that I was typing in huge paragraphs of what was happening and then me waiting for her to respond." Eventually, Sauber left the friendship on her own and quit the app.
When she decided to get help for sleeping issues last fall, she found her way back to a traditional therapist. And although her schedule was still tight, she was able to schedule FaceTime sessions with the therapist, which helped. The sleep issues, she felt, required a relationship with a live therapist who could notice how her body was responding to stressors.
Wright says that the live aspect of traditional therapy can be instructive in guiding a patient's care.
"Being face-to-face allows a therapist to pick up on body language. Maybe a person looks away when they're talking about a particular topic, or somebody's affect doesn't match up with the content of what they're talking about. For example, they're talking about something that's traumatic and yet they're smiling. That kind of nuance can be lost in texts or even e-mails."
Still, Sauber said she could see the benefits of the apps for different types of personalities and situations.
"I can see it being helpful for people who may not be comfortable being in person with someone because they're shy or just uncomfortable about their body language or may be just better communicating behind a screen," she said.
As far as the future of this kind of therapy, Lieberman says that Talkspace is hard at work expanding its network of clinicians and investing in research and science. The company is also working to develop partnerships with employers and health plans to offer the service to more people.
"Our intention to is to make therapy – a profession we think can lead to meaningful change in anybody's life – as common as going to the dentist or hitting the gym."
"These technology-based approaches can supplement the face-to-face work that you do."
[Correction: An earlier version of this article mistakenly implied that the company Woebot offers licensed mental health professionals to speak with patients. Woebot offers a chatbot service, a fully automated conversational agent, to help patients with anxiety and depression.]
Jessica Fitzjohn, a postdoctoral fellow at the University of Canterbury, demonstrates the novel breast cancer screening device.
Researchers at the University of Canterbury and startup Tiro Medical in Christchurch, New Zealand are hoping their new device—which doesn’t involve any radiation or compression of the breasts—could increase the accuracy of breast cancer screening, broaden access and encourage more women to get checked. They’re digging into clues from the way buildings move in an earthquake to help detect more cases of this disease.
Earthquake engineering inspires new breast cancer screening tech
What’s underneath a surface affects how it vibrates. Earthquake engineers look at the vibrations of swaying buildings to identify the underlying soil and tissue properties. “As the vibration wave travels, it reflects the stiffness of the material between that wave and the surface,” says Geoff Chase, professor of engineering at the University of Canterbury in Christchurch, New Zealand.
Chase is applying this same concept to breasts. Analyzing the surface motion of the breast as it vibrates could reveal the stiffness of the tissues underneath. Regions of high stiffness could point to cancer, given that cancerous breast tissue can be up to 20 times stiffer than normal tissue. “If in essence every woman’s breast is soft soil, then if you have some granite rocks in there, we’re going to see that on the surface,” explains Chase.
The earthquake-inspired device exceeds the 87 percent sensitivity of a 3D mammogram.
That notion underpins a new breast screening device, the brainchild of Chase. Women lie face down, with their breast being screened inside a circular hole and the nipple resting on a small disc called an actuator. The actuator moves up and down, between one and two millimeters, so there’s a small vibration, “almost like having your phone vibrate on your nipple,” says Jessica Fitzjohn, a postdoctoral fellow at the University of Canterbury who collaborated on the device design with Chase.
Cameras surrounding the device take photos of the breast surface motion as it vibrates. The photos are fed into image processing algorithms that convert them into data points. Then, diagnostic algorithms analyze those data points to find any differences in the breast tissue. “We’re looking for that stiffness contrast which could indicate a tumor,” Fitzjohn says.
A nascent yet promising technology
The device has been tested in a clinical trial of 14 women: one with healthy breasts and 13 with a tumor in one breast. The cohort was small but diverse, varying in age, breast volume and tumor size.
Results from the trial yielded a sensitivity rate, or the likelihood of correctly detecting breast cancer, of 85 percent. Meanwhile, the device’s specificity rate, or the probability of diagnosing healthy breasts, was 77 percent. By combining and optimizing certain diagnostic algorithms, the device reached between 92 and 100 percent sensitivity and between 80 and 86 percent specificity, which is comparable to the latest 3D mammogram technology. Called tomosynthesis, these 3D mammograms take a number of sharper, clearer and more detailed 3D images compared to the single 2D image of a conventional mammogram, and have a specificity score of 92 percent. Although the earthquake-inspired device’s specificity is lower, it exceeds the 87 percent sensitivity of a 3D mammogram.
The team hopes that cameras with better resolution can help improve the numbers. And with a limited amount of data in the first trial, the researchers are looking into funding for another clinical trial to validate their results on a larger cohort size.
Additionally, during the trial, the device correctly identified one woman’s breast as healthy, while her prior mammogram gave a false positive. The device correctly identified it as being healthy tissue. It was also able to capture the tiniest tumor at 7 millimeters—around a third of an inch or half as long as an aspirin tablet.
Diagnostic findings from the device are immediate.
When using the earthquake-inspired device, women lie face down, with their breast being screened inside circular holes.
University of Canterbury.
But more testing is needed to “prove the device’s ability to pick up small breast cancers less than 10 to 15 millimeters in size, as we know that finding cancers when they are small is the best way of improving outcomes,” says Richard Annand, a radiologist at Pacific Radiology in New Zealand. He explains that mammography already detects most precancerous lesions, so if the device will only be able to find large masses or lumps it won’t be particularly useful. While not directly involved in administering the clinical trial for the device, Annand was a director at the time for Canterbury Breastcare, where the trial occurred.
Meanwhile, Monique Gary, a breast surgical oncologist and medical director of the Grand View Health Cancer program in Pennsylvania, U.S., is excited to see new technologies advancing breast cancer screening and early detection. But she notes that the device may be challenging for “patients who are unable to lay prone, such as pregnant women as well as those who are differently abled, and this machine might exclude them.” She adds that it would also be interesting to explore how breast implants would impact the device’s vibrational frequency.
Diagnostic findings from the device are immediate, with the results available “before you put your clothes back on,” Chase says. The absence of any radiation is another benefit, though Annand considers it a minor edge “as we know the radiation dose used in mammography is minimal, and the advantages of having a mammogram far outweigh the potential risk of radiation.”
The researchers also conducted a separate ergonomic trial with 40 women to assess the device’s comfort, safety and ease of use. Angela was part of that trial and described the experience as “easy, quick, painless and required no manual intervention from an operator.” And if a person is uncomfortable being topless or having their breasts touched by someone else, “this type of device would make them more comfortable and less exposed,” she says.
While mammograms remain “the ‘gold standard’ in breast imaging, particularly screening, physicians need an option that can be used in combination with mammography.
Fitzjohn acknowledges that “at the moment, it’s quite a crude prototype—it’s just a block that you lie on.” The team prioritized function over form initially, but they’re now planning a few design improvements, including more cushioning for the breasts and the surface where the women lie on.
While mammograms remains “the ‘gold standard’ in breast imaging, particularly screening, physicians need an option that is good at excluding breast cancer when used in combination with mammography, has good availability, is easy to use and is affordable. There is the possibility that the device could fill this role,” Annand says.
Indeed, the researchers envision their new breast screening device as complementary to mammograms—a prescreening tool that could make breast cancer checks widely available. As the device is portable and doesn’t require specialized knowledge to operate, it can be used in clinics, pop-up screening facilities and rural communities. “If it was easily accessible, particularly as part of a checkup with a [general practitioner] or done in a practice the patient is familiar with, it may encourage more women to access this service,” Angela says. For those who find regular mammograms uncomfortable or can’t afford them, the earthquake-inspired device may be an option—and an even better one.
Broadening access could prompt more women to go for screenings, particularly younger women at higher risk of getting breast cancer because of a family history of the disease or specific gene mutations. “If we can provide an option for them then we can catch those cancers earlier,” Fitzjohn syas. “By taking screening to people, we’re increasing patient-centric care.”
With the team aiming to lower the device’s cost to somewhere between five and eight times less than mammography equipment, it would also be valuable for low-to-middle-income nations that are challenged to afford the infrastructure for mammograms or may not have enough skilled radiologists.
For Fitzjohn, the ultimate goal is to “increase equity in breast screening and catch cancer early so we have better outcomes for women who are diagnosed with breast cancer.”