Through your platform, you regularly come into contact with people who are struggling with mental health problems, Dr. Hanne Horvath. Have you noticed a change in users in the last few months?
dr Hanne Horvath: Our patient numbers have risen sharply in recent years. On the one hand, this is certainly due to the fact that we have become better known. But of course also because the demand has increased enormously. The advantage of our digital program is of course that those affected can start directly and thus bridge the waiting time for a therapy place. Our medical devices are like an interactive online course in which participants answer many questions and exercises in writing, among other things. We actually see that issues like the war play a role for people. But the dark season and loneliness are also often discussed.
Let's stay with the dark season. Why is it that we are more prone to mental problems in autumn and winter?
The darkness plays a role in this. When it's dark outside, our brain releases other hormones. When our body prepares for tiredness, it produces fewer happy hormones, for example, which we then lack. Light is definitely good for the mood. But I'm pretty sure that the cause of the so-called winter blues is quite complex. For example, many people are less active in the cold half of the year than in spring and summer. And activities like exercising or hanging out with friends are great mental health stabilizers. It is not for nothing that positive activities are very central to many therapy procedures, including within our medical products.
Do you have a tip for people who are now noticing: I'm less active, would like to change that, but don't really know how to go about it?
I don't have to do the same things I did in the summer. In the end, it's really just about getting active. Just knowing that activity is related to mental health often leads to a more conscious approach to it. Even if you don't necessarily feel like it, you're more likely to do it anyway. And this "nevertheless" is what it's all about. In the case of psychological problems in particular, I have to go through with a certain behavior for a while before I feel it. For example, I can go for a walk or make phone calls at any time of the year.
Apart from activities, are there other ways to prevent winter depression?
I would really recommend everyone to take a prevention program. This is available from us and many other providers digitally and is now also accepted by most health insurance companies. In such courses I learn a lot about mental health, stress management and emotion regulation. These techniques can save you from a big low. This might not sound like super fun at first, but it's really important.
Unfortunately, there are many people for whom prevention is too late. You are currently waiting for a place in therapy with a mental illness – for up to six months. How can you make good use of the waiting time?
Most of those affected only realize after several years that they need help at all. So they wait a very long time before they confide in a doctor. Digital health applications are actually more attractive for many because they are immediately available and can not only bridge the waiting time, but sometimes even replace entire therapies. And: Most of our patients do not do any other psychotherapy after completing one of our programs.
In your online courses, the participants have a psychotherapist who looks after them over the Internet. The relationship between therapist and patient is still considered essential in psychotherapy. Isn't something missing then?
I think it depends on the needs of those affected. There are people who need face-to-face communication. That's perfectly okay too. There is also such a contact as part of our courses: Users receive written feedback from therapists. We have been researching and developing our solutions for over ten years and can clearly see that our concept works - over 30 scientific studies prove this. The so-called therapeutic alliance can also arise via our platform, as we have seen in studies. That means the bond is there - but it's certainly different than when therapist and patient sit in one room. What works most, however, are the psychotherapeutic methods. You should not think of our courses as a translation of classical psychotherapy.
How exactly does online psychotherapy work compared to classic therapy?
The participants log in with us and then work actively on their program for several weeks. There are various modules that you then work through on a weekly basis. For example, they watch videos, write something down or do exercises. These are all psychotherapeutic methods that would also exist in classical therapy. Just on my own. In addition, the participants are given information on topics related to mental health. So they always know why they are doing something and what it brings them.
Online therapy is now standardized. Each participant goes through the same program. How individual can such psychotherapy be?
That's a criticism I hear a lot. When we ask our patients, we usually get the feedback that they experience the program as very individual. Bringing your own themes, thoughts and feelings to the program makes it a unique journey for everyone. Ultimately, we guide people to reflect on their own lives.
If you are interested in online psychotherapy, you should first make an appointment with your family doctor. Those affected describe their psychological symptoms there. If you don't get an appointment right away, you can alternatively arrange a digital appointment with a doctor via HelloBetter. The doctor then has to make a diagnosis and can then prescribe the appropriate online course on prescription. The prescription must then be forwarded to the health insurance company. This, in turn, reports back after a few days with the access code for the portal. And then we can start. By the way: Courses that are not yet covered by health insurance can be booked for 299 euros.
What can online psychotherapy do that regular therapy cannot?
The great opportunity of digital psychotherapy is that we can reach people much earlier in the course of the disease. Namely at the point where they still want to get back on their feet on their own. Many do not want to do psychotherapy because they prefer to solve their problems on their own instead of getting help from doctors or psychotherapists. With our offer we can prevent many diseases from becoming chronic.
Artificial intelligence and digitization offer many possibilities. How do you think these will change psychotherapy in general in the future?
The keyword here is "in the long run". We can already see that even after ten years and numerous studies, it is still hard work to get such a medical product into the supply. And we haven't included artificial intelligence yet. In ten or twenty years, however, such innovative technologies will play a major role. We are already seeing that voice recognition can be used to diagnose depression more quickly. But it will take a while before this also arrives in practices. The future of psychotherapy is also digital. Not only but also.
You say it takes time - what's the problem?
Changes always take a little time, as we see regularly in the development and adoption of vaccines. Nevertheless, I am convinced that every politician should actually push online therapy because it could prevent a lot of suffering and close gaps. Mental illnesses are still largely untreated.