Tag: generative AI

Reading of the Week: Nudging Sobriety – the New JAMA Psych Paper; Also, Torous & Topol Weigh Generative AI and Wilson on Thick Skin

July 10, 2025 /

From the Editor

Substance work can be lifesaving. But it’s also challenging, as many patients continue to misuse illicit drugs or drop out of care or both. Evidence supports using incentives, including financial ones, to nudge patients toward sobriety. This approach, known as contingency management, includes tools such as vouchers and prizes.

But what forms of nudging work best? And how much of a financial incentive is needed? In a new JAMA Psychiatry paper, Carla J. Rash (of the University of Connecticut) and her co-authors attempt to answer these questions by looking at contingency management. In a systematic review, they drew on 112 protocols from 77 studies, analyzing types of nudges like vouchers (which may be exchangeable for, say, retails items) and prizes (a chance to win things like gift cards) and the amounts of money involved. The authors walk on a familiar path – the literature goes back four decades – but provide a meaningful update. “Based on these findings, weekly incentive magnitude estimates are $128/week for voucher protocols and $55/week for prize-based protocols.” We consider the paper and its implications. 

ChatGPT is the most downloaded app in history with people using it for everything from finding recipes to writing emails. How could generative AI be used for mental health? In a perspectives paper for The Lancet, Drs. John Torous (of Harvard University) and Eric J. Topol (of the Scripps Research Translational Institute) discuss this important and timely topic. “Despite considerable promise, research is still required to establish AI’s benefit and safety for promoting mental health.”

And in the third selection from Academic Psychiatry, Dr. Ariel E. Wilson, a resident of psychiatry at Kaiser Permanente Oakland, writes about patient rights, certifiability, and the weight of making good decisions. The author asks if psychiatrists need to have thick skin. “The challenge in psychiatry lies in finding a balance – creating our own semi-permeable membrane that allows us to protect ourselves from feeling the sting of every emotion we encounter, while also maintaining empathetic and trusting relationships with our patients.”

DG

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Reading of the Week: More Therapy, More Inequity? The New JAMA Psych Study; Also, Dr. Reimer on Living with Depression and Generative AI & Biases

January 23, 2025 /

From the Editor

What has been the most significant innovation in mental healthcare delivery in recent years? It wasn’t a new medication or therapy, but the widespread adoption of the webcam in 2020. Over the course of a handful of pandemic weeks, psychiatrists and therapists switched to virtual sessions, making it easier for people to receive care, including psychotherapy, unbound by geography, and thus addressing inequity – or, at least, that was the hope. As noted recently in The New York Times: “In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.”

So, are more people receiving psychotherapy? And has this new era of virtual care resulted in better access for all? Dr. Mark Olfson (of Columbia University) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. Drawing on the data of more than 90 000 Americans, they analyzed trends in outpatient psychotherapy in the US, finding more care than ever before. That said, they note greater inequity: “psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access.” We consider the study and its implications.

As doctors, we often shy away from discussing our health, especially our mental health – even with our own physicians. This is particularly concerning because doctors have a higher suicide rate than the general population, yet fears of vulnerability, judgment, and stigma keep many of us silent. In this episode of Quick Takes, I sit down with Dr. Joss Reimer, president of the Canadian Medical Association, who openly shares her own experiences with depression, as a doctor and as a patient. “We all need help sometimes.”

And in the third selection, Matthew Flathers (of Harvard University) et al. analyze AI depictions of psychiatric diagnoses in a new paper for BMJ Mental Health. They tested two AI image models with different diagnoses and commented on the results. “Generative AI models acquire biases at every stage of their development – from societal prejudice in online training data, to the optimisation metrics and safety guidelines each developer puts in place. These layered biases persist even when their precise origins remain elusive.”

DG

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