MonthSeptember 2019

Reading of the Week: Can Machine Learning Improve Psychotherapy? The New JAMA Psychiatry Paper; Also, Santa Ono on His Mental Illness

From the Editor

“Compared with treatment of physical conditions, the quality of care of mental health disorders remains poor, and the rate of improvement in treatment is slow. Outcomes for many mental disorders have stagnated or even declined since the original treatments were developed.”

Are there two sentences more disappointing to read? One in five Canadians will experience a mental health problem this year – and yet we have basic problems with quality (and access).

Could AI and machine learning help?

In the first selection, we consider a new JAMA Psychiatry paper which opens with the two sentences above. The University of Cambridge’s Michael P. Ewbankand his co-authors don’t simply bemoan the status quo but seek to change it – they “developed a method of objectively quantifying psychotherapy using a deep learning approach to automatically categorize therapist utterances from approximately 90  000 hours of [internet-delivered CBT]…” In other words, by breaking therapy down into a couple of dozen techniques and then employing machine learning, they attempt to match techniques with outcomes (patient improvement and engagement), with an eye on finding what works and what doesn’t. And, yes, you read that right: they drew on 90 000 hours of therapy. They show: “factors specific to CBT, as well as factors common to most psychotherapies, are associated with increased odds of reliable improvement in patient symptoms.”

machinelearninginmarketing-1621x1000Can computers (and machine learning) improve human therapy?

In the second selection, we consider the comments of University of British Columbia President Santa Ono about school and the stresses of school. Ono speaks about his own struggle with depression. “I’ve been there at the abyss.”

DG

 

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Reading of the Week: Behavioural Economics & Mental Illness – the New JAMA Psychiatry Paper; Also, the Strange History of Lithium

From the Editor

Can we nudge people to better choices? Economists, psychologists, and psychiatrists have all considered this idea. Though early work looked at pensions and finance, more recent studies in behavioural economics have considered topics in health care, like helping smokers quit.

This week, we open with a new paper that considers the concept of delay discounting in people with major mental illness. “Delay discounting” is a clunky term for the value that people place on rewards over time. Take two individuals, Paul and Peter, offered the same deal: they can be given $100 today or $200 in three months – Paul wants the $100 now while Peter is willing to wait for the bigger reward of $200. Paul, then, has more delay discounting than Peter.

Existing literature shows delayed discounting for people who have addiction and ADHD diagnoses. But what about others with mental disorders? McMaster University’s Michael Amlung and his co-authors study delay discounting by doing a meta-analysis, pulling data from 43 studies involving eight psychiatric disorders in this new JAMA Psychiatry paper. “To our knowledge, this meta-analysis is the first quantitative synthesis of delay discounting findings in psychiatric disorders, except ADHD and addictive disorders. This meta-analysis provides relatively strong evidence that delay discounting is a transdiagnostic process in psychiatric disorders.”

4-nudge_elephantBehavioural economics (and nudging): different for those with mental disorders

In our second selection, we consider a longer essay on lithium for bipolar and its first champion. The University of Groningen’s Douwe Draaisma, a professor of the history of psychology, writes about urine, guinea pigs, and the beginning of the psychopharmacological era.

DG

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