15. August 2022
Our life is accompanied by apps: for shopping lists, social contacts, any notes, our sport activity or even finances. Everything is becoming more digital and available faster. In many areas this is a relief, but can this also be implemented in the health sector? For a few years now, there have been so-called digital health applications (DiGAs), which, among other things, can provide knowledge about various clinical pictures or be a kind of symptom diary for those affected. So why shouldn’t psychotherapy also be possible via app?
The term “digital health applications” covers apps that are designed to detect, treat and improve diseases. They are also suitable for monitoring the state of a disease and have the intention of making everyday life easier for those affected. An example would be a health app for people with depression, which organizes the medication intake and helps to record the symptoms. They can also provide audios or videos for exercises for headaches or help with managing alcohol consumption. DiGAs are also useful for:
Usable on a smartphone, tablet or computer, the various applications can be used to help people manage their symptoms. The aim is also to use the applications to create a common interface between patients, psychotherapists and doctors. Since 2020, there has even been the option of billing DiGAs to health insurers as part of psychotherapeutic or medical treatment
There are now a great many different health apps on the market, and it is not easy for users to tell whether they are useful and handle private data confidentially. For this reason, digital health apps are reviewed by the government and listed in a directory at the Federal Institute for Drugs and Medical Devices. The “Psyche” category now includes around ten applications, with new ones being added all the time. Together with a psychotherapist or doctor, a decision can then be made in favor of a DiGA and a prescription for this can be submitted to the health insurance company. As soon as the health insurer and the app manufacturer have carried out an anonymous data comparison, patients receive an activation code and can use the app free of charge
Digital health apps are not only free of advertising, they also offer the following additional advantages:
Bridging waiting times: Currently, the search and waiting time for a therapy place is very lengthy. With DiGAs, those affected receive help immediately. Likewise, there are often longer time gaps between two appointments with therapists and doctors, which can be bridged in this way
Time savings and flexibility: For any appointments, waiting times in the waiting room as well as the journey are eliminated. In the context of psychotherapy, for example, diagnostic questionnaires can be completed easily from home at any time
Safety: In contrast to personal contact with other patients in the waiting room or the doctors and psychotherapists themselves, there is no risk of infection when using the apps, especially for high-risk patients
Low inhibition threshold: With some mental illnesses, such as anxiety disorders, it is often difficult to leave the house and take advantage of treatment services at all. Using a DiGA can be the first step for those affected to find their way into therapeutic treatment and increase their self-efficacy.
It is not possible to make a general statement that a DiGA is particularly suitable for a specific clinical picture – it is very individual and must be decided by the psychotherapists and physicians treating the patient. Its use must also fit the course of therapy and its content, and it must be checked for possible side effects for each patient. In the case of a very impulsive patient, for example, premature termination of the program or failure could mean a complete discontinuation of therapy. Accordingly, it is important in each case to weigh the costs and benefits for the individual patient
In order for a DiGA to be officially approved, the manufacturer must submit an application for approval to the Federal Institute for Drugs and Medical Devices. The institute sets high standards in terms of data protection, user-friendliness, quality of medical content and patient safety. In addition, the benefits must outweigh any risks of use and the efficacy must be sufficiently proven by the positive supply effect. This effect exists if the DiGA is empirically proven to help a large proportion of patients improve their health. This may include symptom relief, as well as knowledge acquisition or better symptom management. It is also possible for manufacturers to obtain provisional approval through a fast-track process and provide further scientific evidence of the positive effects over the course of the first year
Last but not least, it is again important to mention that apps for health can very well complement, but not replace, psychotherapeutic treatment. Particularly in the context of talk therapy, nonverbal communication through facial expressions, gestures and body language is an important source of information for diagnostics and indication, for example. The establishment of a trusting relationship is also crucial for the success of treatment. Great care must also be taken to ensure that the use of these apps is not contraindicated. For example, apps with exposure exercises should not be used under any circumstances in acute psychosis. Also, education prior to treatment requires direct contact to sufficiently reassure that the patient has understood what treatment they are consenting to. Thus, it is not possible to replace psychotherapy with an app. However, the digital world offers new innovative possibilities for faster and more sustainable therapy effects and should definitely be considered by both patients and practitioners.