Center Highlights

CTBH is pleased to share the article below covering our recent Digital Health Summit.

‘From Ideas to Impact: Symposium on Digital Therapeutics’ (Dartmouth News – November 1, 2023 – Full Article)

Article Excerpt: Hosted by the Center for Technology and Behavioral Health, the digital heath summit, now in its second edition, is the only one of its kind situated in an academic institution. Besides clinical and computer science researchers, it brings together diverse stakeholders—providers, regulators, payers, and investors, as well as representatives from global pharma—to create pathways for translating ideas in the space of digital health to impact.

‘Dartmouth to Host Summit on Digital Therapeutics’ (Dartmouth News – October 18, 2023 – Full Article)

Article Excerpt: The Clinically-Validated Digital Therapeutics: Innovations in Scientific Discovery, Clinical Applications, and Global Deployment event will gather experts from diverse sectors of the health care industry—researchers, providers, regulators, payers, and investors, as well as representatives from global pharma—to help shape a vision for making digital therapeutics accessible to all.

“The goal of the summit is to bring together a really broad group of stakeholders in the space of digital health, and have a shared dialogue about where are we at this moment in time and how we can work together to accelerate the pace at which we can get the most effective and most engaging tools into the hands of people all over the world,” says CTBH Director Lisa Marsch.

‘Technology fueled America’s youth mental health crisis, but it can help end it‘ (The Washington Post – September 21, 2023 – Full Article)

Article Excerpt: Substance abuse, which is both helping drive the mental health crisis and is drastically undertreated with nearly 90 percent of sufferers going without treatment, offers an example of the power of technology to provide clinical care in underserved areas or in cases in which stigmatization prevents people from seeking the help they need. Lisa Marsch and her team at the Dartmouth Center for Technology and Behavioral Health (CBTH) created and validated the first Food and Drug Administration-cleared digital therapeutic for the treatment of opioid addiction, which provides cognitive behavioral therapy interventions though the user’s digital device and has since helped roughly double rates of abstinence by lowering the threshold for access to treatment.

CTBH is pleased to share the article below covering our recent Digital Mental Health & AI Symposium.

‘Symposium Focuses on Digital Tech for Mental Health’ (Dartmouth News – September 19, 2023 – Full Article)

Article Excerpt: The one-day event brought together leading experts to discuss how new technologies are changing the landscape of mental health care and reflect on the challenges of converting promising research into real-world applications that are beneficial, ethical, and equitable.

Congratulations to Dr. Alan Budney who is being honored with two awards.

Alan was selected to receive the Outstanding Alumni Award for 2023 from the Department of Psychology at Penn State’s College of Liberal Arts. This award is in recognition of Alan’s widespread research on the development and evaluation of innovative behavioral treatments for substance abuse, in particular for cannabis use disorders in adults and adolescents. 

Alan has also been selected for the Vermont Addiction Professionals Association (VAPA) Anthony Quintiliani Lifetime Achievement Award for his “immeasurable” contributions to the addiction field.

Congratulations to Alan!

‘Detecting Potential Medication Side Effects in Treating Depression and Anxiety’ (Geisel News – April 19, 2022 – Full Article)

Article Excerpt: New findings in a cross-sectional study by Michael V. Heinz, MD, a postdoctoral research fellow affiliated with the AI and Mental Health: Innovation in Technology Guided Healthcare Lab at Geisel School of Medicine’s Center for Technology and Behavioral Health, published in JAMA Network Open, suggest a significant association between antidepressant use and measured movement, even when accounting for depression. Individuals treated with antidepressants had an overall lower level of physical activity.

‘Geisel School of Medicine and Dartmouth-Hitchcock Researchers Receive Prestigious Colombian National Academy of Medicine Award’ (Geisel News– October 28, 2021 – Full Article)

Article Excerpt: Today, researchers from the Center for Technology and Behavioral Health (CTBH) at Dartmouth’s Geisel School of Medicine, Dartmouth-Hitchcock (D-H), and Pontificia Universidad Javeriana in Bogotá, Colombia, received an award—one of that country’s most prestigious in medicine—from Colombia’s National Academy of Medicine for their work implementing a new primary care model for widespread access to diagnosis and treatment of depression and unhealthy alcohol use. This care model harnesses mobile health technology to increase the reach of science-based mental health care.

‘Into the Wild’ (Dartmouth Medicine – August 6, 2021 – Full Article)

Article Excerpt: Neuroscientist Jeremy Manning, PhD, wants to understand the causal link between exercise, mental health, and cognitive performance—his Contextual Dynamics Lab researches human memory and he has a few ideas about how the three may be connected… With funding from CTBH (Center for Technology and Behavioral Health)’s Pilot Core, Manning and (Lorie) Loeb pulled together Dartmouth-wide experts in human memory, physiological changes associated with exercise and cognition, remote sensing technologies and software development, and data analysis/app design—a collaboration that included undergraduate and graduate students as well as faculty—to launch the pilot study.

Are You Ready For A Prescription For Treatment Tech? (OPEN MINDS– April 22, 2021 – Full Article)

By Monica E. Oss

The global digital therapeutics market size was estimated at $3.5 billion in 2020 and is expected to reach $4.4 billion in 2021. Analysts estimate a compound annual growth rate of 23.1% and predict that the market will reach $19.1 billion by 2028 (see Digital Therapeutics Market Size & Trends Report, 2021 – 2028). Investments by venture capital as well as pharmaceutical companies in this space are growing.

Why does this matter to specialty provider organizations caring for consumers with chronic and complex conditions? And why now? We got some great perspectives on the current possibilities with digital therapeutics from Lisa Marsch, Ph.D., Director of the Center for Technology and Behavioral Health at Dartmouth College, our keynote speaker at the OPEN MINDS Technology & Analytics Institute during the session, Digital Therapeutics For Behavioral Health: Anytime/Anywhere Health Care and the ensuing thought leader discussion. We talked with her about how digital therapeutics can improve treatment outcomes for consumers with mental illness and substance use disorders when used in conjunction with traditional service delivery and medications.

How is a digital therapeutic different from a wellness app? Dr. Marsch defined digital therapeutics as clinical grade software to prevent, treat, or manage a disease or disorder. She said, “It’s taking clinically validated medical treatments for various health conditions and delivering those treatments entirely through software. So it’s packaging an entire model of care into a seamless digital delivery platform.” Digital therapeutics could include cognitive behavioral therapy, problem solving therapy, techniques to promote medication adherence, and more. However, there is no synchronous communication with clinical professionals—all content and functionality is embedded in the interactive software platform that delivers the therapeutic tools.

Dr. Marsch said, “It’s kind of like a clinician in your pocket. Digital therapeutics tools can extend the reach and the impact of clinicians, be available to patients 24/7, and really reinforce what’s being offered to them in a clinical setting.” Prescription digital therapeutics require authorization by the Food and Drug Administration (FDA), and can only be prescribed by a clinical professional after clinical trials. And, the FDA recently sped approval of digital therapeutics—particularly in psychiatry (see Enforcement Policy For Digital Health Devices For Treating Psychiatric Disorders During the Coronavirus Disease 2019).

What’s out there? Digital therapeutics fall into four categories—those that address a medical condition, manage or prevent a medical disorder or disease, support medication, or treat a medical disease or disorder.

Digital therapeutics that address a medical condition include The Dexcom G6 system for glucose monitoring combined with BlueStar, which is FDA cleared for Type 2 diabetes self management (see Welldoc & Dexcom Expand Strategic Partnership To Integrate Platforms & Offer An Integrated Type 2 Diabetes Management Solution).

Among digital therapeutics that help manage disorders is the game-based prescription digital therapeutic, EndeavorRx, to improve attention function in children with attention deficit/hyperactivity disorder (see FDA Approves First Game-Based Prescription Digital Therapeutic For Children With ADHD).

Digital therapeutics that optimize medication include smart pills equipped with embedded sensors or cameras, such as Abilify MyCite, that track ingestion and alert care coordinators about missed dosages (see OIG Approves Otsuka Plan To Loan Smartphones To People Taking Its Digital Medicine Antipsychotic, Abilify MyCite).

A digital therapeutic that treats a medical disease or disorder is the FDA-cleared Freespira to reduce or eliminate symptoms of panic attacks, panic disorder, and post-traumatic stress disorder (PTSD) in 28 days (see Highmark Health Expands Access to Freespira’s Digital Therapeutic Treatment for Panic Attacks, Panic Disorder & PTSD). Germany recently approved Deprexis, a depression treatment therapeutic, for medical prescription and reimbursement (see Germany Approves Digital Mental Health Apps For Prescription). Otsuka Pharmaceutical and Click Therapeutics have launched a fully remote clinical trial to measure the effectiveness of a digital therapeutic intervention for major depressive disorder (see Otsuka & Click Therapeutics To Develop Digital Therapeutics For Major Depressive Disorder). CenteredVR, a virtual reality-enabled mindfulness and stress management program for clinical professionals has been shown to decrease stress levels by 34% on average, reduce anxiety, and enhance the overall mental health and well-being (see BehaVR’s CenteredVR Eases Emotional Toll Of COVID-19 On Health Care Workers).

Are digital therapeutics effective? Over many years of research, digital therapeutics used in behavioral health treatment have yielded outcomes that are comparable to or better than care delivered by clinical professionals. For example, an intensive behavior change digital tool for substance use disorders (based on the community reinforcement model used by clinical professionals) tested by Dr. Marsch and her team has been shown to roughly double drug abstinence rates when used as part of the therapeutic model, compared to standard addiction treatment. A study found that 86% of consumers treated with Freespira’s digital therapeutic for panic attacks were symptom-free immediately after treatment and 73% were still symptomfree 12 months post treatment. The majority of patients were free of panic attacks and/or reduced their symptoms and avoidance behaviors one year after Freespira treatment. Mean overall medical costs were reduced by 35% from $548 to $358 per member per month (PMPM). There was a 65% reduction in emergency department costs from $87 to $30 PMPM. Median pharmacy costs were reduced by 68% from $73 to $23 per member per month. (see Evaluating The Impact Of Freespira On Panic Disorder Patients’ Health Outcomes & Healthcare Costs Within The Allegheny Health Network).

Digital therapeutic tools allow personalization of care. Dr. Marsch explained, “They don’t always have to work the same way. We don’t have to have 12 sessions or eight sessions of treatment every time. Digital therapeutics can be responsive to the needs and preferences of the individual and the changing clinical trajectories of individuals over time.” These tools also expand access to care, helping to reach the majority of people who have a substance use disorder or mental health problem but don’t seek care in traditional models. “If a digital therapeutic is the only thing that someone would try in the privacy of their own home, it can be a stepping stone to seeking care with a clinician in a health care system,” Dr. Marsch said. However, it’s important to be mindful of the digital divide and look for workarounds when lack of bandwidth impedes access for consumers.

So how do clinical professionals prescribe from the plethora of digital therapeutics starting to enter the market? The key is what consumers will get coverage for. A digital therapeutic currently costs $900 to $1,200 out of pocket but the big challenge is that the Centers for Medicare and Medicaid is not yet reimbursing for digital therapeutics. However, more employers and health plans are starting to cover the cost—and CVS and ExpressScipts are developing digital therapeutic formularies. Children’s Community Health Plan in Wisconsin has made Freespira’s digital therapeutic for panic attacks and PTSD available to all consumers, including those covered by Medicaid (see Children’s Community Health Plan Is First In Wisconsin To Offer New Digital Therapeutic Treatment For Panic Attacks, Panic Disorder, & PTSD). Freespira is also covered by Highmark, the fourth-largest Blue Cross Blue Shield-affiliated health plan serving 5.6 million health plan members in Pennsylvania, Delaware, and West Virginia (see Highmark Health Expands Access To Freespira’s Digital Therapeutic Treatment For Panic Attacks, Panic Disorder & PTSD). And, in Indiana, the state is providing access to Pear Therapeutics’ FDA-authorized prescription digital therapeutics for the treatment of substance use and opioid use disorder to participating provider organizations in a variety of outpatient treatment settings and opioid treatment programs (see Pear Announces Indiana Family & Social Services Administration Division Of Mental Health & Addiction Will Provide Access To Prescription Digital Therapeutics For Substance Use & Opioid Medication Addiction).

And for provider organizations that are in (or are considering) value-based payment arrangements, tools that can improve outcomes for consumers and save costs system-wide can increase “preferred provider” status with payers. And for provider organizations in fee-for-service arrangements, prescribing digital therapeutics for consumers could free up the time of clinical professionals (with fewer face-to-face sessions) and help them see more consumers.

For more on enhancing your digital toolbox and improving treatment efficacy, check out these resources in The OPEN MINDS Circle Library:

• Strategy & Sustainability For The Next Normal: It’s the Technology, @)(*@#&$!
• Specialty Care Strategy For A Tech-Enabled Future
• Digital Transformation – The OPEN MINDS Guide To Getting The Most Value From Your Technology Investments
• The Specialty Provider Organization Technology Checklist
• Adding AI To Your Digital Toolbox Can Add Value
• “Plussing Up” For The Digital Era: Robots Become Reality
• Are We Ready For AI-Driven Care? It Depends…
• Expanding Your Digital Toolbox With Chatbots
• When The Answer Is “I’m Sorry, I Can’t Help You With That”
• The Technology Triple Whammy

And for even more, join us on May 13 for the Executive Web Forum, Making Value-Based Reimbursement Work – Best Practices In Program Design & Management. Ashley Gibson, Director Of Payer Relations, Contracts & Utilization, Hazelden Betty Ford Foundation and Donna Esposito, Director of Payer Relations, THRIVE DETECT, will share case studies on the development, design, and management of value-based reimbursement programs.

This reprint appears with the permission of OPEN MINDS. For more information, visit their website at www.openminds.com. To contact the author, email openminds@openminds.com.

‘Dartmouth Startup Wins Funding for Remote Physical Therapy Monitoring System’ (Dartmouth Engineering – April 20, 2021 – Full Article)

Article Excerpt: A team of researchers from Dartmouth has been awarded nearly $225,000 from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), to develop and test “BandPass,” a remote-sensing resistance band exercise system that would allow health care providers to monitor, evaluate, and guide patients as they use the device in their homes.

‘Capturing Recordings of Your Medical Encounters. Are some discussions too important not to record?’ (Psychology Today – April 22, 2021 – Full Article)

Article Excerpt: … with colleagues at the Preference Laboratory in Dartmouth, (Dr. Paul Barr) began exploring the nascent phenomenon of patients secretly recording their physician visits. Then, after attending a 2014 lecture given by Sigel Bell of the Open Notes research group (more here), Barr started to see huge potential benefits in openly recorded clinic visits and started to learn more about the idea. A theme that kept popping up was that while many patients felt uncomfortable about making secret recordings, they did so anyway because “some discussions were too important not to record.”

Dr. Marsch will deliver the address, Digital Therapeutics For Behavioral Health: Anytime/Anywhere HealthCare, virtually on March 11, 2021. A forum will follow to further the discussion and allow for questions. In anticipation of the presentation, and to offer additional insight into the field of digital therapeutics,  OPEN MINDS interviewed Dr. Marsch and released an Executive Briefing entitled “Supercharging The Workforce With Digital Therapeutics”.

Link to the full article here (subscription required to view, no fee).

Catherine Stanger, PhD, has been awarded a 5 year grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to test the effectiveness of innovative behavioral intervention tools in helping to improve the health of high-risk patients who suffer from Type 1 diabetes. The project, Thinking Outside the Clinic: A Digital Health Approach for Young Adults with Type 1 Diabetes, addresses a key public health issue with broad applicability to many diseases and health behaviors: how to help people follow a complicated medical regimen and achieve better health outcomes.

See here for a press release from Dartmouth’s Geisel School of Medicine.

‘Building Mental Health Care into Latin American Primary Care’ (Dartmouth Medicine Magazine – Spring 2017 – Full Article)

Article Excerpt: A five-year initiative, the Latin American Mental Health Project is funded by a grant from the National Institute of Mental Heath (NIMH), part of the National Institutes of Health, to Dartmouth’s Center for Technology and Behavioral Health (CTBH).

“This is an ambitious project with a lot of partners and a broad array of stakeholders, including researchers, governmental organizations, patient advocacy organizations, insurance company payers, and non-governmental and multilateral organizations in both the United States and Latin America,” says Lisa Marsch, PhD, director of CTBH and the project’s principal investigator.

‘Evaluating the Feasibility and Accessibility of Digital Technology Interventions for Global Mental Health’ (Geisel NewsCenter – April 20, 2017 – Full Article)

Article Excerpt: “Lead author John A. Naslund, MPH, a doctoral candidate at The Dartmouth Institute for Health Policy and Clinical Practice, and an affiliate of Dartmouth’s Center for Technology and Behavioral Health, wrote the paper along with colleagues at Dartmouth, the London School of Hygiene and Tropical Medicine, the Public Health Foundation of India, and the University of Washington. Though he believes technology has the potential to positively affect the treatment of mental disorders, he admits it is not a panacea, but rather a valuable tool whose use should be based on evidence.”

This paper was published in Lancet Psychiatry

The House Bipartisan Heroin Task Force held a roundtable to hear from physicians and public health advocates about heroin and synthetic drug abuse. Topics covered how these drugs affect the brain, communication between doctors and families on treatment plans for drug abusers, the need for alternative pain medicine, and the potency of synthetic drugs.

Watch video on C-SPAN

The U.S. National Institute of Mental Health has awarded a U19 Cooperative Agreement Grant to the Center for Technology and Behavioral Health at Dartmouth College.   This award will support a partnership with a broad array of stakeholders, including leading researchers in the U.S. and Latin America, governmental organizations, patient advocacy organizations, insurance company payers, and non-governmental and multilateral organizations to scale-up mental health implementation research and build sustainable research capacity and science-based policies and programs in Latin America.

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A video featuring Dr. Lisa Marsch, Director of the Center for Technology and Behavioral Health, is featured as part of the Addiction Technology Transfer Center Network’s “Telehealth Tuesday” series. In this downloadable video, Dr. Marsch discusses the benefits of utilizing telehealth technologies to deliver behavioral health services, including using the Therapeutic Education System (TES). Key benefits of using TES will be presented, including how it can provide patients/clients and clinicians the tools needed to facilitate integration of behavioral and physical healthcare in ways that transcend the boundaries of the clinic to offer a mechanism for achieving improved health and social well-being.

Watch Video

‘There’s An App for That—Integrating devices and gadgets into clinical practice’ (February 3, 2014)

Article Excerpt: Health apps for smartphones are nothing new. There are a plethora of devices and gadgets available to help us manage our own health and wellness—fitness apps tracking diet and exercise are the most common. And health-care providers are increasingly using sophisticated technology-based medical applications to help patients manage chronic illnesses. Recently, there has also been an increase in applications designed to address behavioral health, including substance abuse and mental illness.

Read full release

Lisa A. Marsch, PhD –  Director of the Center for Technology and Behavioral Health, is featured in the most recent edition of Dartmouth Medicine:  The Magazine of The Geisel School of Medicine at Dartmouth.

http://dartmed.dartmouth.edu/

Established in July of 2011, The Center for Technology and Behavioral Health (CTBH) is housed within the Dartmouth Psychiatric Research Center (PRC) in Lebanon, NH. Offices are located on the fourth floor of the Rivermill Commercial Center, a renovated mill building on the Mascoma River that dates back to 1881. To accommodate the CTBH team, the PRC acquired and renovated additional office and conference room space in the same building. To mark the completion of renovations, PRC and CTBH members celebrated with an Open House. While an essential component of the CTBH is virtual, with an interdisciplinary team of researchers located in institutions across the country, this newly expanded space provides the Dartmouth team members with an enhanced work environment and room to grow.

The Center for Technology and Behavioral Health has opened a monthly seminar series. These presentations feature members of both the Scientific and Dissemination & Implementation Advisory Boards and other distinguished collaborators. The goal is to educate the CTBH team about a given Board member’s area of expertise and the most cutting-edge developments in their field of relevance to the Center’s Aims. Featured speakers to date include David Gustafson, Ph.D., who spoke about the growing evidence-based for Smartphone systems to improve patient outcomes. Linda Collins, Ph.D., from Penn State discussed the innovative Multiphase Optimization Strategy (MOST) for designing new behavioral interventions, and Robert Evans from Google presented PACO, his team’s open source mobile experience sampling research platform.

The seminar series is video recorded and available for viewing in the Seminar Series section of this website.