Skip to main content
Log in

E-Health in Diagnostik und Therapie psychischer Störungen

Werden Therapeuten bald überflüssig?

E-Health in diagnosis and therapy of mental disorders

Will therapists soon become superfluous?

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Verwendung von digitalen Medien in der Gesundheitsversorgung (E-Health) bei der Diagnostik, Prävention und Behandlung von somatischen und psychischen Störungen ist inzwischen weitverbreitet und immer leichter zugänglich. Neben der Aufzeichnung von objektiven Daten können subjektive Daten über die aktuelle Symptomatik, die Befindlichkeit, Lebensqualität, Schlaf, physiologische Indikatoren und andere Merkmale einer Person mit sog. Wearables oder Apps erfasst und über einen längeren Zeitraum zu bestimmten Intervallen oder auch in Zusammenhang mit bestimmten Ereignissen oder Behandlungen dokumentiert werden. Therapeutische Onlineprogramme geben den Teilnehmern meist auf Basis von Selbstmanagementprogrammen Informationen über die Symptome, den Verlauf, die Ursachen und Behandlungsoptionen einer Erkrankung und entsprechende Erklärungen, therapeutische Übungen oder Hinweise an die Hand. Der Forschungsstand sowie verschiedene Anwendungsszenarien bzw. einzelne Produkte aus dem Bereich E‑Health zur Diagnostik und Therapie werden präsentiert und diskutiert. Die meisten Studien wurden dabei mit Personen durchgeführt, die an Angststörungen oder Depressionen leiden. Für eine erfolgreiche Anwendung dieser Programme im Bereich Diagnostik und Therapie bedarf es jedoch der Anleitung, Motivation und der begleitenden Unterstützung. Therapeuten werden weiterhin gebraucht! Wir empfehlen dringend die Aufwendung von entsprechenden Ressourcen, um solide Anwendungsszenarien zu entwickeln und zu validieren, eine sinnvolle Integration in die Versorgung zu gewährleisten und die Therapeuten entsprechend in der Nutzung von elektronischen Medien zu schulen. Therapeuten sollten zu Experten in der Verwendung digitaler Medien und von E‑Health werden und diese in ihre Behandlung integrieren.

Abstract

Digital media, online programs, and electronic health systems are available and easily accessible for diagnostic, prevention, and intervention of somatic and psychiatric disorders. These modern tools can assess objective as well as subjective information about acute symptoms, wellbeing, life quality, sleep, physiological indicators, etc. Wearables and apps collect data over days and weeks in the real world of subjects. This information can be used to document baselines as well as changes over time influenced by events or interventions. Online treatment programs provide information for education about symptoms, course, origin, and treatment options of a disorder. They also support a patient’s self-help via self-management, exercises, and techniques. We illustrate and discuss modern diagnostic and therapeutic eHealth options. We also review the empirical evidence for online interventions and refer to typical examples. Most studies have been conducted with subjects suffering from depression and anxiety. Electronic health systems do not work just by recommending a program or providing access to an online platform. Patients need to be motivated to lock in and work with a program. They need support and guidance through online programs. Therefore, we claim that therapists need to become experts in digital media and electronic health systems to support patients and to integrate apps and online programs into their treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. World Health Organisation (2011) mHealth: New horizons for health through mobile technologies Global Observatory for eHealth series. Vol. 3. Geneva: World Health Organisation. http://www.who.int/goe/publications/ehealth_series_vol3/en/. Zugegriffen: 18. Aug. 2017

    Google Scholar 

  2. Fahrenberg J (1996) Ambulatory assessment: issues and perspectives. In: Fahrenberg J, Myrtek M (Hrsg) Ambulatory assessment: computer-assisted psychological and psychophysiological methods in monitoring and field studies. Huber, Bern, S 3–20

    Google Scholar 

  3. Wolf M (2011) Supportives monitoring in der Psychotherapie. Psychotherapeut 56:485–491

    Article  Google Scholar 

  4. Lui JHL, Marcus DK, Barry CT (2017) Evidence-based apps? A review of mental health mobile applications in a psychotherapy context. Prof Psychol Res Pr 48(3):199–210

    Article  Google Scholar 

  5. Shen N, Levitan M‑J, Johnson A, Bender LJ, Hamilton-Page M, Jadad RA, Wiljer D (2015) Finding a depression app: a review and content analysis of the depression app marketplace. JMIR Mhealth Uhealth 3(1):e16

    Article  PubMed  PubMed Central  Google Scholar 

  6. Berger T (2015) Internetbasierte Interventionen bei psychischen Störungen. Fortschritte der Psychotherapie, Bd. 57. Hogrefe, Göttingen

    Google Scholar 

  7. Stange JP, Hamilton JL, Olino TM, Fresco DM, Alloy LB (2017) Autonomic reactivity and vulnerability to depression: a multi-wave study. Emotion 17(4):602–615

    Article  PubMed  Google Scholar 

  8. Shinba T (2014) Altered autonomic activity and reactivity in depression revealed by heart-rate variability measurement during rest and task conditions. Psychiatry Clin Neurosci 68(3):225–233

    Article  PubMed  Google Scholar 

  9. Sanders W, Abaied J (2015) Motivational systems and autonomic functioning: overlapping and differential contributions to anhedonic depression and anxious arousal. Motiv Emot 39(4):602–612

    Article  Google Scholar 

  10. Loeffler SN, Hennig J, Peper M (2017) Psychophysiological assessment of social stress in natural and laboratory situations: using the experience sampling method and additional heart rate measures. J Psychophysiol 31(2):67–77

    Article  Google Scholar 

  11. Faurholt-Jepsen M, Frost M, Vinberg M, Christensen EM, Bardram JE, Kessing LV (2014) Smartphone data as objective measures of bipolar disorder symptoms. Psychiatry Res 217(1):124–127

    Article  PubMed  Google Scholar 

  12. Ben-Zeev D, Scherer EA, Wang R, Xie H, Campbell AT (2015) Next-generation psychiatric assessment: using Smartphone sensors to monitor behavior and mental health. Psychiatr Rehabil J 38(3):218–226

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stiftung Deutsche Depressionshilfe (2017) STEADY-Studie. https://www.deutsche-depressionshilfe.de/forschungszentrum/aktuellestudien/steady-studie. Zugegriffen: 7. Aug. 2017

    Google Scholar 

  14. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS ONE 5(10):e13196. https://doi.org/10.1371/journal.pone.0013196

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cuijpers P, Donker T, Johansson R, Mohr DC, van Straten A, Andersson G (2011) Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0021274

    PubMed  PubMed Central  Google Scholar 

  16. Păsărelu CR, Andersson G, Bergman Nordgren L, Dobrean A (2017) Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. Cogn Behav Ther 46(1):1–28

    Article  PubMed  Google Scholar 

  17. Melioli T, Bauer S, Franko DL, Moessner M, Ozer F, Chabrol H, Rodgers RF (2016) Reducing eating disorder symptoms and risk factors using the internet: a meta-analytic review. Int J Eat Disord 49(1):19–31

    Article  PubMed  Google Scholar 

  18. Kuester A, Niemeyer H, Knaevelsrud C (2016) Internet-based interventions for posttraumatic stress: a meta-analysis of randomized controlled trials. Clin Psychol Rev 43:1–16

    Article  PubMed  Google Scholar 

  19. Sijbrandij M, Kunovski I, Cuijpers P (2016) Effectiveness of internet-delivered CBT for Posttraumatic Stress disorder: a systematic review and meta-analysis. Depress Anxiety 33(9):783–791

    Article  PubMed  Google Scholar 

  20. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E (2014) Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13:288–295

    Article  PubMed  PubMed Central  Google Scholar 

  21. Baumeister H, Reichler L, Munzinger M, Lin J (2014) The impact of guidance on Internet-based mental health interventions — a systematic review. Internet Interv 1(4):205–215

    Article  Google Scholar 

  22. Spek V, Cuijpers P, Nyklíček I, Riper H, Keyzer J, Pop V (2007) Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 37(3):319–328

    Article  PubMed  Google Scholar 

  23. Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH (2016) Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011565.pub2

    PubMed  Google Scholar 

  24. Gilbody S, Littlewood E, Hewitt C et al (2015) Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. BMJ 351:h5627

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kenter RMF, Cuijpers P, Beekman A, van Straten A (2016) Effectiveness of a web-based guided self-help intervention for outpatients with a depressive disorder: short-term results from a randomized controlled trial. J Med Internet Res 18(3):e80. https://doi.org/10.2196/jmir.4861

    Article  PubMed  PubMed Central  Google Scholar 

  26. van der Vaart R, Witting M, Riper H, Kooistra L, Bohlmeijer ET, van Gemert-Pijnen LJ (2014) Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study. BMC Psychiatry 14:355

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kleiboer A, Smit J, Bosmans J et al (2016) European COMPARative effectiveness research on blended depression treatment versus treatment-as-usual (E-COMPARED): study protocol fora randomized controlled, non-inferiority trial in eight European countries. Trials 17:387. https://doi.org/10.1186/s13063-016-1511-1

    Article  PubMed  PubMed Central  Google Scholar 

  28. DGPPN, BÄK, KBV, AWMF (2015) S3 – Leitlinie/Nationale Versorgungs-Leitlinie Unipolare Depression – Langfassung. 2. Auflage Version 5. www.leitlinien.de/mdb/downloads/nvl/depression/depression-2aufl-vers5-lang.pdf. Zugegriffen: 26. Sept. 2017

    Google Scholar 

  29. Berger T, Hämmerli K, Gubser N et al (2011) Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther 40:251–266

    Article  PubMed  Google Scholar 

  30. Twomey C, O’Reilly G, Meyer B (2017) Effectiveness of an individually-tailored computerised CBT programme (Deprexis) for depression: a meta-analysis. Psychiatry Res 256:371–377

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martin Hautzinger.

Ethics declarations

Interessenkonflikt

S. Lüttke ist an einem Start-up zur Entwicklung von Wearables für den Einsatz bei psychischen Erkrankungen beteiligt. M. Hautzinger hielt mehrfach von der Firma Servier unterstützte Fortbildungsvorträge zu dem Thema Onlineinterventionen bei Depressionen. M. Hautzinger und K. Fuhr waren an vom BMBF geförderten Studien zur Wirksamkeit von Onlineinterventionen (Deprexis, GO) beteiligt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lüttke, S., Hautzinger, M. & Fuhr, K. E-Health in Diagnostik und Therapie psychischer Störungen. Bundesgesundheitsbl 61, 263–270 (2018). https://doi.org/10.1007/s00103-017-2684-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-017-2684-9

Schlüsselwörter

Keywords

Navigation