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The future of internet interventions

The online world has created ‘access to more affordable, equitable and timely’ treatment provision, according to Dr Pepijn van de Ven

A diverse group of researchers and practitioners has long examined the online capability for the provision of remote medical treatment, but the current pandemic has greatly accelerated the process.

Dr Pepijn van de Ven, a senior lecturer in the Department of Electronic and Computer Engineering (ECE) at UL and course director on the Masters in Artificial Intelligence (AI), believes the smart use of technology in providing remote treatment is “so important”.

Dr van de Ven has been involved with the International Society for Research on Internet Interventions (ISRII) since 2013. The society brings together an enormously diverse group people from the health domain – global leaders in the field.

He got involved after participating in an EU project to develop technical solutions to support online delivered depression and anxiety interventions.

With technology starting to play a more important role in internet interventions due to advances in data science and machine learning, the UL academic was asked to join the ISRII board and recently took over the presidency of the group.

His own research is interested in the application of AI and machine learning to mobile sensing for biomedical applications with a particular focus on the area of eMental Health.

He explains that internet interventions is a catch all term for providing treatment remotely through a website, a mobile app, via SMS message or Zoom meeting – all of which have clearly seen an explosion of use in recent times.

Dr van de Ven explains.

Internet interventions are quite popular for mental disorders such as depression, anxiety, stress disorders and substance abuse disorders.

“However, internet interventions are certainly not limited to mental health - any intervention that includes a behavioural component is in
principle suitable for online delivery. Many disorders are caused by lifestyle and changing that using a behavioural intervention may be a very effective and cheap way of intervening.”

Dr van de Ven is currently involved in a large Australian study as a technical consultant looking at the ‘big six’ risk factors for chronic disease - poor diet, inadequate physical activity, sedentary behaviour, alcohol misuse, smoking and unhealthy sleep patterns - and how these effect children.

He says: “Although we already know that currently not all these behaviours can be accurately measured automatically,
there certainly is scope to intervene by measuring behaviours and then trying to address potential issues in young people
with appropriate internet interventions. I think this is a good example of why internet interventions, and smart use of technology in these interventions, are so important.”

The use of internet interventions has been crucial to the provision of care during the pandemic, Dr van de Ven explains.

“The obvious reason is that, with face-to-face contact suddenly near impossible, within months internet interventions became
the de-facto mode of treatment for many patients. So in this sense, the pandemic has given a boost to what I think was inevitable for economic reasons, as well as because of the lack of capacity in our health system.

“However, the pandemic has also resulted in a shockingly increased incidence in mental disorders, especially depression.

Some of our ISRII members have trained more than 1000 therapists in online delivery of mental health interventions in the space of a few months. This of course has been crucial in meeting the increased demand for such services,” he adds.

Dr van de Ven, who is training surgeons, accountants, designers, PhD students and others on the two year MSc in AI at UL – which is fully online – believes that the future for internet interventions is “bright” and that there is “more and more evidence that these interventions work”.

“We are currently involved in a large study in São Paulo, Brazil, in collaboration with the University of São Paulo,
King’s College London and the University of Bristol. In this study, health workers with generally secondary education and
minimal health training, provide a mental health intervention using a tablet-based system developed by UL,” he says.

“We have shown that this treatment is effective and much cheaper than a conventional intervention provided by trained specialists, such as psychologists and psychiatrists. Hence, our intervention could have an incredible impact on people’s lives, especially as all our participants live in São Paulo’s various favelas. They otherwise simply would not have access to adequate mental health services.

“There is a stigma around mental health, for many patients it is difficult to acknowledge their mental health issues to significant others or their GP. As a result, it may be more appealing to do online behavioural activation and problem solving therapy, two popular behavioural therapies, than to make the big step and schedule an appointment with a therapist.

“Technology has a massive role to play in this success. Smart phones have been dubbed the ‘therapist in your pocket’ and
can be used to better understand your behavioural patterns, including risk behaviours, and even mood. As such, they may
be able to offer you snippets of interventions exactly when and where these are most important to you.

“This of course brings with it the extremely important responsibility of ensuring that this data is not, and cannot be abused. This is a larger theme in data science, and particularly artificial intelligence and machine learning. But just like machine learning is here to stay, I believe internet interventions are here to stay, and here to create access to more affordable, more equitable and more timely interventions for all of us.”
- Alan Owens