The weekly papers: Going human-free in mental health care; the risks and benefits of legalising cannabis; new thinking about paranoia; higher body temperatures and depression
What caught my eye in the mental health literature this week?
Chatbot-guided access to mental health services
A paper in Nature Medicine describes how the use of a chatbot (a pink bubble called Limbic) to “guide patients proactively through the referral process and provide personalized and empathetic responses” changed the pattern of self-referrals to The Service Formerly Known as IAPT (okay, the proper name is “Talking Therapies for Anxiety and Depression”).
They showed that Limbic appeared to facilitate self-referral, especially among ethnic minorities, and very dramatically in gender minorities. Why? The factors are listed in table 1, including “Convenient”, “Provided hope”, and “Self-realization”. Most intriguingly of all, “Human free” was listed as a positive factor: “Individuals mentioned the human-free nature of the chatbot in a positive way and removing the anxiety of talking to humans”.
What can we take from this? An empathetic chatbot is preferable to filling in a form unaided, which is perhaps not the biggest surprise. It’s possible that chatbots can help a more diverse range of people to access services…but what then? Would a “human free” therapist be safe, acceptable, and appealing as people continue their journey?
Smoke gets in your eyes: the risks and benefits of legalising cannabis
Legalising cannabis can reduce stigma and overpolicing, both of which have mental health consequences. But it can also increase use of the substance, and hence risk of psychosis. What's the answer? This BJPsych editorial doesn't identify any simple solutions, but that's kind of the point.
New thinking about paranoia
A concise summary by Dan Freeman of the changing approach to psychological interventions for paranoia. Many years ago, I wrote an editorial that predicted “schizophrenia” would gradually fall apart as a diagnosis, as the multiple, possibly quite diverse pathways into psychoses were elucidated. Freeman is saying something similar, but from another angle—essentially, he implies that looking at a bundled construct like “schizophrenia” isn’t very useful from a therapeutic point of view. Better to pull part the individual factors that one can clearly define and tackle them. As he puts it, “focus on a specific experience can lead to a radical shift in understanding.”
Higher body temperatures associated with depression
The TemPredict study of around 20k people collected self-reported depressive symptom data, as well as self-reported and wearable-recorded body temperatures over 7 months. The researchers report a correlation between higher self-reported and wearable sensor-assessed body temperatures and greater depression symptom severity (when awake, clearly).
This replicates the results of (much) smaller studies, although of course this doesn't mean the data are perfect. The use of a finger thermometer as opposed to core temperature is a limitation, especially when it comes to the data recorded during sleep, when core temperature goes down and peripheral temperature goes up.
As for the mechanisms underlying this association...there's a rich variety to choose from, including HPA axis dysregulation and inflammation.
And what about potential therapeutic use? Awkwardly, such data as exists suggests that heating people up actually reduces depressive symptoms—the authors suggest that this might be because heat exposure makes bodily cooling mechanisms cut in, ultimately bringing temperature down. I'm not quite convinced of this argument, but wouldn't write off the potential benefits of understanding more about the relationship between thermoregulation and mood.