by Thomas Lethenborg | Aug 4, 2020 | Blog
Monsenso offers a smartphone app that supports online therapy by enabling users to share valuable health data with their therapists in real-time.
What is online therapy used for?
Online therapy, also called e-therapy or teletherapy has many advantages and it gives users access to therapy services offered by mental healthcare providers from the comfort of their home. Therapists can use one of the many secure platforms available to connect with their patients through video conference, phone calls or chat functionality. It also helps reach people who have very busy schedules and can’t spare the commute, or those are not too comfortable with face to face appointments.
Online therapy can be effective to treat many mood and behavioural disorders such as depression, anxiety, bipolar disorder and borderline personality disorder. In fact, according to research led by McMaster University online therapy can be more effective than in person.
Just as in traditional therapy, it is important that the goals of online therapy are created by both, the therapist and the client.
Cognitive behavioral therapy (CBT) is a tool used to treat a number of mental and physical health issues, and due to its flexibility, CBT online offers many of the benefits found in the face-to-face model. CBT is widely available online, so people experiencing unwanted symptoms linked to anxiety, depression, and other conditions should view it as a viable option to treat their overall well-being.
Dialectical Behavioural Therapy (DBT) is a type of therapy that primarily involves skills training such as mindfulness, emotional regulation, and distress tolerance to assist individuals to better manage emotional distress. It also provides problem-solving strategies to identify and alter harmful behaviors and replace them with constructive ones.
An app that supports online treatment
Before using the Monsenso smartphone app to support his therapy, Peter Hagelund, followed the typical therapeutic setting. His psychiatrist would schedule an appointment every two-three weeks, and they would discuss Peter’s previous weeks. On most occasions, Peter would say that he had been doing fine, but sometimes he forgot important details that he wanted to discuss.
Now, instead of relying on Peter’s memory during the consultation, his psychiatrist can access his data and see how he has been doing, as it happened. He can view how much he has sleept, how much he exercises, how much he drinks, the levels of anxiety he has, and other relevant aspects to his treatment and his disorder.
Mads Trier-Blom, another Monsenso user, said that the app helps him to be more connected with his clinician, Bente, who intervenes when she can see that he is not feeling well, to help him avoid having an episode.
Psychiatrist Kristoffer Södersten from PsykiatriResurs in Sweden says that the accuracy from a diagnosis obtained can very much depend on many factors such as cultural background and how comfortable the patient is in the conversation. Therefore, it can be very arbitrary the diagnosis a patient receives.
The information gathered from the Monsenso smartphone app helps him get a consistent and clearer view of an individual’s mental health. He finds the Monsenso mHealth solution to be particularly helpful in capturing relevant objective data. The solution provides a comprehensive and easily accessible overview of relevant patient data, such as the individual’s overall day score, his mood, the number of hours he slept, and if he took his medication. The smartphone app also collects sensor data, such as physical activity, social activity, phone usage and voice features which helps to supplement the subjective data provided.
The Monsenso mHealth solution has helped mental healthcare providers to get an overview of an individual’s historical data and correlation analysis. It also helps them identify the triggers and early warning signs everyone has, enabling them to intervene at an early stage before they have an episode, such as in the case of Mads.
Besides, the smartphone app helps users to be more aware of their mood, their symptoms and the reason why these symptoms appear. It also provides them with useful skill-training content to help them deal with stressful situations.
by Thomas Lethenborg | Mar 26, 2017 | News, Research Projects
The MDiary Study is a part of the ENTER project (previously called E-Mental), which is being done in collaboration with The Mental Health Services in the Region of Southern Denmark (MHS), the South Denmark University, Aalborg University, and Context Consulting.
Borderline Personality Disorder (BPD)
Borderline is a serious and debilitating mental disorder characterised by difficulties with regulating emotions, which leads to unstable and self-destructive behaviours and relationships.
The prevalence of BPD is 1%-5%. Borderline increases the risk for suicide by 4-fold, while patients with comorbid Borderline and a tendency to self-harm have a further 2-fold attenuated risk. BDP is difficult to treat, and even more difficult when co-occurring with other disorders.
Dialectical Behaviour Therapy (DBT) is the best validated treatment for Borderline, showing medium to large effect sizes as compared to treatment as usual. Dialectical Behaviour Therapy uses self-monitoring as the mainstay of treatment, which helps patients regulate their emotions by means of emotional regulating skills, and reduce problem behaviour.
Self-monitoring has traditionally been done by means of daily paper diaries. The latest developments in smartphone applications have generated alternatives for ecological momentary assessments of problematic behaviour with the additional functionality of prompting patients to practice skills targeting emotion regulation.
Monsenso’s involvement in the the mDIARY Study for patients with Borderline Personality Disorder
Monsenso is responsible for improving and developing additional modules in the Monsenso mHealth solution. The objective of the study is to prove that the Monsenso DBT (Dialectical Behavioural Therapy) solution is a reliable and clinically valid way to collect patient data, helping individuals with Borderline learn these skills at home, speeding up their recovery.
1. Skills tracking
In the current configuration used for DBT treatment, skill used throughout the day can be selected in the daily self-assessment. This does not take into account if the patients have actually learned the skills, meaning a lot of skills will appear in the list that the patient might not already know. In order to personalise the skills list, and in order to help the clinicians and patients to track progress, the skills should be configurable in the sense that the patient is able to indicate whether they have not learned a skill, are in the process of learning a skill, or know it and can use it meaningfully. This implies, the the patients should be able to, on their phone in the configuration section of the self-assessment, to have a list of skills appear, where they can indicate whether a skill is ’Not known’, ’In the process of learning’, or ’I know it, and can use it meaningfully’.
2. Skills training / Psychoeducation
In DBT treatment, skills are an essential part, and patients often have a paper folder, with descriptions of each skill. In the current version, the “Action Plans”’ in the system have been used for this purpose, but it makes it not very easy to overview and need more ways of presenting content, like videos or sound files. The layout is like a dictionary, where patients can find information regarding their disorder, usual treatment regime, prevalence, but alto typical issues and preventive actions that could be taken.
3. Emotion rating (BEARS)
One parameter in the self-assessment should be named “Emotions” in which joy, anger, attachment, sadness, safety, anxiety, pride and shame can be be rated on a scale of 0-4:
0 – Not at all
1 – A Little
2 – Some
3 – A lot
4 – Extreme
It is important that they are all rated in the same screen, as the patient need to see these together.
4. Therapy progress / Detailed overview
The overview screen will be re-designed and focus around “Therapy progress,” highlighting the progress over time. The key factor for the use of the system should be the patients’ development and progress over an extended period. The scope of the solution is to include graphs of the clinical questionnaires in the overview screen, which includes summary scores of DERS, BSL, and HTQ questionnaires. Likewise the attendance percentage should be shown, together with the Hierarchy level rated by the clinician.
To learn more read:
by Thomas Lethenborg | Feb 1, 2016 | Borderline, News
Monsenso will begin clinical trials of smartphone-based DBT (Dialectical Behavioural Therapy) for patients with Borderline Personality Disorder in collaboration with the Mental Health Services in the Region of Southern Denmark (MHS).
Smartphone-based DBT
The objective of the mDiary Study is to evaluate the Monsenso mHealth solution for borderline patients with respect to reliability, validity and clinical efficacy as an adjunct to DBT.
Borderline is a severe mental disorder characterised by difficulties with regulating emotions, leading to unstable and self-destructive behaviours. Borderline is difficult to treat, especially when co-occurring with other disorders. DBT is the best validated treatment for borderline, showing an improved health outcome compared to other types of treatment.
DBT uses skills training and self-monitoring as the pillar of treatment, teaching patients to regulate their emotions and reduce problem behaviour. Traditionally, self-monitoring was made through paper-based self-assessments. However, new technology has generated an alternative to ecological momentary assessments of problematic behaviours with the additional functionality of prompting patients to practice skills targeting emotion regulation.
Methods
Participants will be borderline patients from psychiatric DBT units. The study includes two phases: the first phase will be a three-month pilot study where patients will be randomised to use either the pen and paper version of the diary card or the Monsenso mHealth app. The number of missing data will be compared, and data quality of the app versus established clinical measures will be evaluated. User satisfaction will be assessed with focus group interviews.
The second phase will include a two-year multi-centre randomised controlled trial. In both conditions patients will be followed for one year. Half of the patients will receive the mHealth app that includes mobile DBT (mDBT) coaching suggestions and instructions on how to use it. The second half will be asked to download an app that only collects sensor data, but will continue to use the traditional paper-based self-assessments.
Expected results
The mDiary Study will prove that the Monsenso smartphone-based DBT is a reliable and valid way to collect patient-data, helping individuals learn these skills at home, speeding up their recovery.
To read the press release click here.
