History, Controversy, Future

Hydrotherapy

• Water used as a treatment for body and mind

• Historically related to religious rituals

• Commonly used to treat physical conditions

Psychosurgery

Leucotomy - Egas Moniz

Lobotomy - Walter Freeman

• neurosurgery for mental disorders still used but more ethical today

• developed to treat Parkinson’s disease

• reversable

Past to Present

• Past: coercion, institutional convincing, social control

• Present: autonomy, informed consent, least prestirive practice

Need to be responsible in research conduct and in its communication

• don’t underestimate the potential for bias

Antidepressants

2008

• only ‘worked’ for most severely depressed and most of the effect was a response to the placebo

2018

• all antidepressant were more effective than placcebo

• informed patients and physicians about different antidepressants

Rosenhan Experiment

• Sent 8 pseudo-patients none of which had symptoms or history of mental disorders to 12 psychiatric hospitals without revealing to staff

• All were diagnosed with a disorder and hospitalized

• The study catalyzed important developments: shift towards new DSM (more reliable, need to fix poor staff-patient interactions, and confront the gap between theory and practice in diagnosis

Diagnosis: Are we over diagnosing?

• no doubt we are seeing increases in mental health problems

• we are seeing big increase in med use

Diagnosis: Are we diagnosing differently?

• Increase in autism diagnoses between 1998 and 2018

• Over time, fewer autism symptoms were required for a clinical diagnosis of autism

• “Finding support for the notion that the observed increase in autism diagnoses is, partly the by product of changed in clinical practice”

Diagnosis: How do we conceptualize mental health?

In the context of mental health, it involves a wider range of conditions and less severe problems coming to be regarded as disorders

• Positive: might be more likely to self-diagnose/seek help

• Negative: “prevalence inflation” milder forms of distress labelled as disordered

Why Change is Needed

• Treatments work but not well enough - not fully recovering

• Current models are too limited - traditional categories fail to capture complexity

• Research-practice gap persist - evidence-based treatments don’t translate well into routine care

• Call for a new era - treatments must evolve

Transdiagnostic Approaches

• RDoC - classification system for better understanding the underlying dimensional processes and the development of psychopathology

• HiTOP = define psychopathology according to a dimensional approach which also investigates those individuals with subthreshold symptoms or unusual symptom profiles, with the aim to reduce the heterogeneity

Digital Therapeutics (DTx)

• Machine learning: to detect suicide risk

• Digital phenotyping: using smartphone and wearable data to predict symptom escalation in conditions like bipolar disorder

• Multimodal integration: combining speech, facial expressions, and text

• Movement analysis: AI models to identify patients with anxiety and depression in real-time based on physical parameters

Immersive Tech (VR/AR)

VRET

• virtual reality exposure therapy

• safer, controlled environments for PTSD, anxiety and phobias

Biological and Behavioral Primers

Therapy+

• enhancing psychological approaches with biological treatments

• mechanistic

Exercise Priming

• using aerobic activity to increase neuroplasticity before a therapy session

Psychedelic-Assisted Therapy

• using substances like psilocybin as catalysts for psychological ‘breakthroughs’ in treatment-resistant cases

Challenges and Ethical Barriers

Data Privacy

• ensuring AI and digital platforms protect sensitive mental health records

Human Factor

• evaluating if “digital empathy” can truly replicate the therapeutic alliance

Equity

• preventing a ‘digital divide’ where only wealthy patients access high-tech interventions