6 February 2024

Categorical and Dimensional Approaches to OCD Diagnoses and Treatment

The categorical approach to psychological diagnoses utilizes pre-compiled criteria to assess and identify certain disorders within individuals. Current categorical approaches will pull strongly on DSM-V. This approach allows for an ease of diagnosis—the list of criteria allows the psychologist or clinician to look for a symptom pattern. However, there is an overlap between many symptoms and non-related mental disorders. Further, recent data finds that psychological disorders present as “comorbid, recurrent/chronic, and exist on a continuum” rather than a neat encapsulation of a handful of symptoms (and manifesting only those few). For obsessive-compulsive disorder (OCD), the behaviors displayed are ‘normal’ human traits expressed to an ‘abnormal’ extent. Maintaining personal cleanliness and hygiene or being organized are seen as normal human behaviors, but sufferers of OCD feel compelled to overexhibit these actions, according to the DSM-V. Taking comorbidity and individual differences into account, the categorical approach is limiting and fails to account for unique individual experiences. Another argument against the categorical approach is that it overpathologizes typical human behaviors. Additionally, if one’s behaviors are not seen as ‘severe enough’, there could be a lack of treatment provided or no diagnosis given.

The dimensional approach provides a more personalized assessment of behaviors. Symptoms are ranked on a continuum of severity, which then allows for comparison between two cases of the same psychological disorder. By removing the boundaries of pathologized behavior, the clinician can note variance “with respect to age-of-onset, severity, symptomatology, impairment, resistance to treatment and a variety of other disorder characteristics”. 

OCD, however, contains a large discrepancy in manifested behaviors. Past the diagnostic criteria of compulsions and obsessions (wherein both do not have to be exhibited in order to be diagnosed with OCD), there are individual specifiers. If the individual patient has ‘good insight’, they are aware of the irrationality of their beliefs, even though they continue to execute them as such. And vice versa, ‘poor insight’ is when the patient insists that the belief is real and is linked to the compulsion. Those with poor insight could believe that the house will burn down if the light switch is not clicked off and on twenty times, while those with good insight may not truly think the house will burn down if the actions are not executed, but will do so just in case. Further, there is the variable of a tic disorder. DSM-V notes that 30% of individuals diagnosed with OCD “have a lifetime tic disorder”.

While a dimensional approach conveys a more personalized showing of levels of severity concerning certain symptoms, it is a more complex process in relation to the categorical approach, which may take up unneeded time. However, dimensional approaches also reveal how more disorder-unique behaviors (for OCD, this could be tendencies to wash hands or to hoard) align in familial comparisons. While a diagnosis through a categorical approach is more often used in clinical settings due to its succinctness and common understanding amongst researchers, a dimensional approach provides more information and specifics.

13 February 2024

Explanations by Cognition: Cognitive and Biological Approaches to Anxiety Disorder Treatment

Biomarkers are biological ‘flags’ that could help inform clinicians on methods of diagnosis and treatment. Cosci and Mansueto (2020) highlight multiple biomarkers that could suggest possible anxiety disorders on the DSM continuum. Cosci and Mansueto note that “[s]tructural or activity changes in the brain regions; changes in N-acetylaspartate/creatine, dopamine, serotonin, and oxytocin; heart rate variability; hypothalamic–pituitary–adrenal axis activity; error-related negativity; respiratory regulation; and genetic variants” could all be viable biomarkers to detect and navigate anxiety disorders within an individual. The increases in muscular tension, breathing rate, and heart rate lead to the exhibition of common anxiety disorder symptoms.

Through a cognitive approach, anxiety is explained by Aaron T. Beck’s schema-based theory of cognitive perspectives, which says that “prepotent maladaptive schematic representations of the self, world and future are activated by matching life experiences.” Echoing Mowrer’s 1947 two-stage learning theory, Beck argues that feelings of anxiety are triggered by feelings of helplessness in reactionary and behavioral processes. Cognitive approaches to treatment seek to shift behavior via “cognitive restructuring” or cognitive behavioral therapy (CBT). In CBT, the patient is taught coping skills to overcome feelings of weakness or to better perform conflict resolution. Beck also shows that through the generic cognitive model (GCM) of CBT treatment, activated schemas lead the individual’s decision to resort to (previously gained) biased ideas within their mind.

Sibrava and Borkovec (2006) reason that worry stems from the lack of control one develops over future negative experiences. In a moment where the individual is experiencing feelings of anxiety, they experience a “freezing response” which is due to “increased muscle tension and reduced variability”. Such responses can accumulate over time, resulting in actions of procrastination.

Hofmann, Asmundson, and Beck (2013) offer cognitive therapy as a method to “increase perceived ability of coping, reduc[e] perceptions of personal vulnerability, and reduc[e] emotional distress.” In Cosci and Mansueto’s approach, biomarkers assist in manufacturing “personalized psychiatric treatments informing about the type, timing, and course of interventions and monitoring the clinical response to them.” These biomarkers, Cosci and Mansueto also surmise, could help in predicting favorable responses to treatment. Therefore, how do biological and cognitive explanations for anxiety disorders function in differing approaches to treatment?

Biologically, as an individual responds to a perceived threat, Grupe and Nitschke (2013) propose that the anterior mid-cingulate cortex (aMCC) “integrates motivational, affective and interoceptive information to provide an instructive signal that influences subsequent action under conditions of uncertainty.” As the aMCC tempers brain connection, past studies have shown that a diagnosis of an anxiety disorder is associated with a shift in aMCC and amygdalic functioning. When the aMCC responds to a threat cue, such as unexpected stimuli, Mathews and MacLeod (2005) figure that the anxiety-prone individual is “more likely to have their attention held even by relatively mild threat cues.” In an individual with a diagnosed anxiety disorder, practices in attention control are recommended.

Medication cannot solely act as a cure for anxiety disorders—when taken correctly and properly, it can only inhibit symptoms. Bandelow et al. (2017) note that psychotropic medications and pharmacological antidepressants such as selective serotonin reuptake inhibitors (SSRIs) bind to gamma-aminobutyric acid (GABA) neurotransmitters in the brain, but “as these bindings sites are widespread in the brain and have non-specific inhibitory effects, the efficacy of benzodiazepines in anxiety disorders cannot be taken as evidence that a dysfunction of the GABA binding site is the cause of pathological anxiety.” Citing a metaanalysis done by Bandelow et al. (2015), Carpenter et al. (2018) note that in placebo-controlled trials, the use of medication to treat panic disorder (PD), generalized anxiety disorder (GAD), and seasonal affective disorder (SAD) was “associated with pooled placebo-controlled effect sizes ranging from 0.17 to 0.96…depending on the medication, suggesting similar efficacy”. However, in order to not just cope but to heal, Carpenter et al. find that CBT treatment provided “significantly greater odds of treatment response” than placebo CBT. Further, their analyses found that “treatments that primarily focused on exposure techniques produced larger effect sizes… than those that included both cognitive and behavioral techniques… and cognitive techniques alone”.

To make CBT services more widely available and accessible in the United Kingdom, National Health Services began implementing a training program called Improving Access to Psychological Therapies (IAPT). This program incorporates not only CBT but a range of talking therapies such as counseling and couples therapy depending on diagnosis and severity. Additionally, IAPT utilizes internet-assisted therapy methods when needed, for treatments like guided self-help or online therapy programs, which further contributes to its convenience.

Cuijpers et al. (2013) finds that the “differences in effects between psychotherapy and antidepressant medication were small to non-existent for major depression, panic disorder and SAD”. While acknowledging that the effect of pharmacotherapies lessens after the patient ceases use, Cuijpers et al. admit to not using long-term results in their analysis as it was deemed unimportant to the set trials. However, their findings that treatment via medication and psychotherapy tactics have similar outcome effects reveal that one treatment method is not more universally prolific than the other.

In their work on biomarkers, Cosci and Mansueto created a model for anxiety disorders that shows the manifestation of symptoms/markers for each stage of a generic diagnosis of an anxiety disorder. They separate anxiety disorders into four phases ranked from least to most severe: prodromal phase, acute manifestation, panic attack, and chronic phase. Under each stage, a variety of clinical markers as well as biological markers are linked, with common continuations between stages shown when needed. In the prodromal phase, for example, the clinical markers or symptoms are less invasive and not fully developed. Cosci and Mansueto refer to this as the early phase of the anxiety disorder, and note that there may be some comorbidity in terms of symptoms with various disorders that the individual patient may not actually have. However, the biomarkers show that “error related, negativity, N-acetylaspartate/creatine, oxytocin, dopamine, serotonin,” are present in individuals in the prodromal phase, with the levels of the neurotransmitters suffering from variation, while the error-related negativity shows a “burst of electrical activity” that occurs when the patient missteps. The aforementioned list of biomarkers is present only in the prodromal stage, acute manifestation stage, and chronic phase. Under all four phases, in opposition, are variance in “genes, structural changes in the brain regions, dysregulation HPA [hypothalamic-pituitary-adrenal] axis, variation in heart rate variability”. However, they also note that if the biomarkers are used to determine diagnosis without the shown clinical markers, there is “poor clinical utility”. By using the staging method, Cosci and Mansueto show that a psychiatric disorder can be separated into multiple layers so that treatment is catered to the symptoms and severity of the individual’s illness. Stage-specification for anxiety disorders is both effective and cost-effective. 

But, how effective is CBT on anxiety disorders? After creating a metaanalysis of 269 studies previously in existence, Hofmann et al. (2012) found that CBT as a treatment for anxiety disorders was “consistently strong, despite some notable heterogeneity in the specific anxiety pathology, comparison conditions, follow-up data, and severity level”. For treating anxiety disorders, CBT has been shown to be very helpful. Hofmann et al. highlight that CBT is however not as widely available as it should be. Initiatives like the IAPT, if followed through on, will help to make more accessible treatments for anxiety disorders but also multiple other mental health disorders, as Hofmann lists that those diagnosed with schizophrenia, personality disorders, bulimia, substance use disorders, and depression could all benefit from CBT as well. Slightly varying from Cuijpers et al. (2013) by collecting follow-up data post-treatment, Carpenter et al. found in their studies on the use of CBT versus placebo talking therapies that “the impact of CBT extends beyond the symptoms of the disorder being targeted, and lasts beyond acute treatment”. Psychological treatment methods such as CBT aim to not just reduce anxious behaviors in the present, but to change the patient’s life (for the better!).

30 January 2024

Interactions of Heritability and Adolescence Conditions: The Origins of Intelligence and its Application

On the topic of nature versus nurture and the questioning of what is and is not an ‘inborn trait’, the addition of intelligence determination, a datum with an arguably developing definition, further complicates such discussions. Linda Gottfredson wrote that intelligence functions as “the ability to deal with complexity”. The concept of the g variable, meaning one’s general intelligence, was conceived by Charles Spearman (1904) to serve as a predictor for future academic success or projected income of an individual. However, Spearman saw intelligence as static, meaning that one’s g quotient could rarely, if ever, shift greatly throughout one’s life. Alfred Binet, a French psychologist most well-known as the creator of an early I.Q. (Intelligence Quotient) test, disagreed with Spearman’s views on fixed intelligence—believing that one’s intelligence was malleable over time. His initial IQ tests were for primary school-aged children, with their scores compared to other children with similar socioeconomic backgrounds in order to determine their ‘score’. Put simply, Binet’s IQ test measured one’s ability to use logic and reason to reach a solution. But, the Stanford-Binet IQ test gives one score to represent one’s intelligence. In Florence Oxley et al. (2023), phenotypic intelligence is broken into six different factors: g, crystallized intelligence, fluid intelligence, memory, non-verbal intelligence, and verbal intelligence. Using more than 400,000 individuals, selected from eleven prior genome-wide association studies (GWAS), this study “predicted phenotypic intelligence with medium effect size”, but found that these score predictions differed when sorted by specific intelligence domains. For example, the team found that verbal intelligence scores in European W.E.I.R.D. (western, educated, industrialized, rich, democratic) countries were around 0.25 higher than that of g. Therefore, how much is one’s intelligence inherited from childhood environmental factors or by one’s genetics? 

The brain consists of gray and white matter. Gray matter executes processing throughout the central nervous system, while white matter assists with further communication within the brain. “Available reports are consistent with the statement that both grey and white matter volumes are positively related to intelligence,” Colom et al. (2022) write, “but that the latter relationship is somewhat greater”. However, this fact alone does not provide enough insight. Dubois et al. (2018) find that only 20% of differences in g can be accounted for by neural processing. 

In a 2016 meta-analysis GWAS, the observed genome-wide polygenic scores (GPS) “predicted 3% of the variance in years of education on average in independent samples,” write Plomin and von Stumm (2018). “Surprisingly, GPS for years of education predicted more variance in intelligence than they predicted for the GWAS target trait of years of education”. From the aforementioned study (which is referred to as EA2, with EA standing for educational achievement) in combination with two others (both in progress at the time of publication) noted by Plomin and von Stumm, the education level of one’s parent correlates 0.30 with the intelligence of the child. Therefore, they surmise that parents’ education “accounts for 9% of the variance in children’s intelligence. This association is, however, confounded by genetics, because children inherit the DNA differences that predict their intelligence from their parents.” Next, Plomin and von Stumm continue by describing how the usage of GPS and genetic association, combined with IQ testing, can be individually used in order to personalize the education system for the growing child, which they refer to as “precision education”. But, Paul Scherz reminds the reader in his 2021 criticism on behavioral genetics, these scores are only predictions, noting in reference to Plomin’s goals for future education that “[o]ne cannot expect teachers to personalize instruction for the genetic make-up of each student in a class…”.

When education is used as a factor towards suggesting or predicting one’s intelligence, it must be noted that there is an obvious socioeconomic issue regarding college- or university-related issues such as financial aid, tuition price, maintaining employment while in school, et cetera. Additionally, Bates, Lewis, and Weiss (2013) state:

For instance, Turkheimer, Haley, Waldron, D’Onofrio, and Gottesman (2003) found that in affluent families, genetic differences accounted for approximately 60% of the variance in IQ, whereas the effects of between-families environmental differences were almost nonexistent. In poor families, however, the pattern was reversed. Gene × SES [socioeconomic status] interactions have been identified in samples of children as young as 2 years old…

Twins are used heavily in behavioral genetics research due to their genetic similarity and (assumed) similar home environment. Using the GPS found in EA2, Plomin and von Stromm  found that the scores predicted “were just as much correlated with intelligence in low socioeconomic status as in high socioeconomic status family environments. GPS provide a particularly powerful approach to test for GE interaction as compared to twin studies.” Here, gene environment (GE) interaction means a “conditional relationship in which the effects of genes on intelligence depend on the environment”. 

Further, Plomin and von Strumm apply their findings to GE correlation, the relationship between one’s personal experiences and their genetic disposition. They find that research using GPS shows how truly present the “nature of nurture” is within the study of twin intelligence development. Their EA GPS, they claim, “correlate with social mobility and capture covariation between environmental exposures and children’s behavior problems and educational achievement”. The genetic consistency connecting education level/years of education and one’s intelligence is “greater than 0.50 in twin studies”, but also sets a ceiling onto the intelligence that EA GPS can actually foretell. 

However, the results of the previously referenced 2013 study by Bates, Lewis, and Weiss proved unique from the neutral discoveries by Plomin and von Strumm—the former found that children in “environments associated with better cognitive development are also associated with increased genetic variance.” Further, Bates et al. figured that childhood environment impacts one’s intelligence past the period of childhood, threading itself into their biological development.

In the mid-1800s, British psychologist Francis Galton ran a study to determine if social prominence is inherited familially or if the offspring of a distinguished individual is only also successful due to a nepotistic promotion. When comparing the socioeconomic outcomes of nephews or adopted sons of high-ranking clergymen to the blood-related sons of wealthy and/or popular men, he found that the direct sons were more likely to “achieve eminence” than the adopted relatives. Galton himself, however, has ‘achieved eminence’ in the realm of eugenics. In fact, he is credited with using the word ‘eugenics’ for the first time. As late as the 1970s, the IQ test that has since morphed from the era of Binet (and continues still to change) was used to determine if individuals were mentally deficient. “There is no doubt at all,” writes Nicholas Mackintosh in his 2011 IQ and Human Intelligence, “that IQ tests were later used to justify sterilization in cases of mental retardation.” He cites that “over 60,000” people were forced into compulsory sterilization by 1964. 

In the case of Galton, who believed that IQ tests would “improve stock” of the population by rooting out the “feeble-minded”, should his study on eminence among the nineteenth-century elite and well-known be treated empirically? While the findings of Plomin and von Stumm provided heavy insight into the impact of parental education onto the intelligence of their children, it was criticized by Scherz as viewing human intelligence “framed in metaphors derived from a computer science”. Scherz also attacked the duo’s ideas for further individualized education through their EA results, likening their plan to a genetic fitness plan where those who are unable to adapt to the skills of their peers will be “deemed unfit for the competition”. Regarding more modern studies, intelligence, in whichever way it is defined by the researcher, still lacks a full understanding. 

There are a myriad of issues when applying such findings to real-life circumstances and outcomes. Take Richard Hernstein and Charles Murray’s 1994 book The Bell Curve, where the authors argue that, writes Nisbett et al. (2012), “racial differences in IQ are likely due at least in part, and perhaps in large part, to genetics”. The book states that black children have an inborn lower intelligence (specifically, IQ) than white children, even suggesting that welfare payments be minimized as it “encourage[s] low IQ women” to reproduce. Hernstein and Murray cite that out of the 102 women they spoke with with Bachelor’s degrees, only one received welfare. They take this to show that low-IQ people are inherently poorer. A variable such as socioeconomic status affects personal opportunity, which then affects the ability to further one’s education. From there, many different outcomes exist, whether they have been predicted by one’s GPS or not.

In today’s state of behavioral genetics, great progress has been made in the studies of intelligence, strengthening what began as ‘simple’ personality tests into the possibility of segmented intelligences. In the question of how much of our intelligence is determined by our childhood environment or by our genetics, establishing one’s intelligence is a process where adolescent environmental factors play no more causal a role than genetics does. A portion of one's intelligence derives by way of genetics and heritability, yet one’s unique environment, home life, and even care and encouragement received also assists in furthering one’s intelligence.

5 March 2024

To E- or Not to E-: Mental Health Treatment in the Digital Age

In the twenty-first century, the world is increasingly dependent on technological assistance. Technology has seeped into almost all facets of daily life, from having real-time conversations with friends living thousands of miles away to doing the crossword on the New York Times app rather than the print version. And, technology has also made its way in recent decades into the healthcare sphere. 

This is especially true in the years during and following the COVID-19 pandemic. With so many people in isolation due to quarantine policies, services that individuals may depend on, such as doctor’s visits and therapy sessions, went online, hosted through a video chat system. Today, teletherapy still functions, and has expanded access to mental health services, removing the barriers of distance from those who live in rural areas or have mobility issues.  As technological approaches to mental health treatment have risen in popularity, so too have they become more complex, and even problematic. With such a dependence being placed on high-tech health care in modern treatment, is it truly an advantageous addition or does it further seclusion and contribute to a reliance on non-human decision-making?

Digital mental health assistance provides many new pathways and approaches for both patient and clinician, benefiting individuals who were previously unable to access therapeutic methods and adding to the ever-extensive body of psychological research through new findings and techniques.

The recent development and widespread usage of teletherapy has aided people in treating their mental health through more convenient practices. As these online visits are more easily flexible than a physical clinic visit, as well as literally existing within the palm of one’s hand, therapy clients are able to fit in a session during the day without having to spend time commuting or away from work. In the same vein, one could have a digital therapy session within their own home, providing comfort as well as support from the familiar setting. Further, utilizing technology for mental health assistance creates more of an availability between the client and doctor. In a trusting therapist relationship, a digital-led connection could also increase ease of communication. While being constantly available outside the workday hours may be overwhelming for the therapist, a quick email or text message exchange may also be useful when patients are in need of immediate assistance. If discussing sensitive issues or very specific events to the point that the patient may be self-conscious or embarrassed regarding its content, digital therapy can allow for a less invasive and more impersonal therapeutical process, and could be conducted anonymously. In comparison to typical in-person and one-to-one therapy styles, teletherapy sessions are able to provide similar treatment “at a lower associated cost”, according to Philippe et al. (2022). A proposal to further reduce the cost of teletherapy would be removing the human doctor from the equation, exchanging the person with an artificial intelligence (AI) software or a virtual avatar.

D’Alfonso et al. (2017) have combined AI with moderated online social therapy (MOST) practices in order to “enhance user engagement and improve the discovery and delivery of therapy content”. The MOST model, and now smartphone application, was created in 2014 and weaves together online peer support with clinician interpretation and assistance. It was created to test the efficacy of digital therapeutic practices for youth mental health treatment. D’Alfonso et al. highlight that MOST includes a social media-esque element, which allows for individuals to speak with those who suffer from similar mental illness in an online setting. According to the MOST website, it provides “therapeutic content, cartoons, activities and practical strategies that work”. The MOST system also utilizes a message exchange platform where the patient is able to chat about their mental health concerns with a moderator, who is a human and responds in real time. However, D’Alfonso et al. recommend that this platform could be enhanced by using an automated suggestion algorithm. This way, a human would not even have to be present on the other end in order for the patient to receive a response. As of the article’s publication in 2017, MOST was currently only being used in small groups, allowing less than a thousand people to use the site at a time. If the automated response technology was utilized, on top of the already present digital options and activities present on the application, more people could seek help at the same time. Translation services could also be used to make the service even more widespread, as at the time of publication, MOST was only available in English. The use of artificial intelligence could also be used to collect data on experiences (Did you find this experience helpful?), personalized questions (Have you ever been to therapy before?), and care follow-up rates (Did they use this service a second time?), as well as more specific data points such as the reason for seeking help and other concerns. 

Some technology-based mental health approaches have not only a digital method of communication but also a computer-generated ‘avatar’ in place of the real therapist, on the other side of the computer screen. AVATAR therapy is used for individuals with clinical diagnoses of schizophrenia spectrum or affective disorder, especially those with symptoms of psychosis or auditory or visual hallucinations. In a study by Craig et al. (2017), 75 patients were given supporting counseling, while the other 75 patients were given AVATAR therapy, where the patients speaks “with a digital representation (avatar) of their presumed persecutor” using the voice of a therapist. Through this, the avatar becomes less aggressive in the mind of the patient, slowly decreasing the grip that the imaginary target holds over them over several sessions. Craig et al. found a significant reduction in subsequent auditory hallucinations after twelve weeks of weekly AVATAR sessions in comparison to those who only received face-to-face counseling. Another similar digital treatment used to treat psychosis is virtual reality cognitive therapy (VRCT). VRCT helps individuals with psychosis or paranoia act out social situations and find techniques to overcome anxious avoidance practices. In Freeman et al. (2022), 174 patients experienced VRCT coupled with a weekly in-person therapy session, while 172 underwent solely the in-person therapy as usual. Freeman et al. found that social avoidance and feelings of distress had significantly reduced after 6 weeks of VRCT in comparison to those who did not receive VRCT. VRCT and AVATAR therapy have both proved tremendously helpful in recent research. In place of medication but used in tandem with one-on-one counseling, maybe technology-based therapy truly is assistive and valuable.

While technological applications to mental health are convenient, cost-effective, and fruitful to both patient and doctor, are e-treatments really as effective? Of course, more years of research will be required to answer that question with certainty. At present, the quality of digital health intervention in comparison to traditional methods of treatment has yet to be evaluated. According to Philippe et al. the ability of healthcare professionals to provide reliable assessments of behavior, manage suicidality, and offer dependable identification of disorder symptoms through the barrier of a computer screen remains unsure. “A lack of information, resources, and understanding of complex patient-related factors”, Philippe et al. posits, “could negatively affect care delivery and overall patient health.”

As with any internet service that collects and shares data, there will concerns regarding privacy and the possibility of security breaches. In a teletherapy session, the patient is providing very intimate and private details of their daily life, in addition to their conscious thoughts about the world around them. One fear that may depreciate teletherapy in the eyes of a prospective patient is a potential data breach, allowing hackers and digital malware to obtain this sensitive personal information. 

For those suffering from social anxiety or agoraphobic symptoms, having the option to remain at home for therapy sessions may seem fruitful to the patient in the moment, but possibly may have a furthering detrimental effect on their mental health. Not leaving the house for a routine, weekly therapy session only contributes to the individual’s routine of social isolation, which may result in feelings of depression, loneliness, and changes in sleep patterns. Further, teletherapy may foster a reliance on technology. While teletherapy works well under certain circumstances (pandemic, illness, social anxiety, et cetera), Philippe et al. believe that continued usage could lead to a lack of empathy on behalf of the therapist. During a remote therapy session, lack of body language and true eye contact could contribute to painting the online patient in a different light than their in-person patients. Skewing the human-on-human interaction through two computer screens, true empathy could be absent when the relationship is purely through video calls, of no fault of the clinician themselves. When patients interact through teletherapy, miscommunication may arise, leading to signs and symptoms being misread. Newer technology can be confusing and exasperating for patients unfamiliar with it. This digital disorientation could also result in a treatment plan not being completed properly. 

Digital mental health treatment is a helpful technique for treating patients. Virtual reality therapy, smartphone applications, teletherapy, and avatar therapies have all shown to be fruitful in recent years in comparison to solely in-person treatment. The malleability of e-treatment adds to its accessibility. However, research is still not wholly convinced of its effectiveness.

For future research, technology has been utilized and embedded into more and more healthcare streams. Machine learning can be incorporated into mental health studies through the development of algorithms to detect certain genetic variabilities. However, fine-tuned technological healthcare systems as well as the aforementioned genetic algorithms “come with no guarantees of fairness, equitability, or even veracity”, write Beam and Kohane (2018). Even at present, technology is unmistakably intertwined in the healthcare practice. Most data collected from patients is inputted into the online database, doctor’s appointments are booked through an online dashboard, and hulking machines such as the magnetic resonance imaging (MRI) scanner and ventilators are used daily. The question that remains is not one of removing what we already have, but if it is indeed generative and constructive to go further.