MHM Magazine

Issue 6 | 2021 | MENTALHEALTHMATTERS | 35 MHM OVERVIEW OF VIMBO THERAPEUTICS APP. The Vimbo app uses a combination of structured modular content, interactive tools, audio content and in-app symptom monitoring. Before users register, the app gives a brief overview of CBT and how Vimbo can support them. Once they have completed registration and authentication, they receive a series of measures. These include the Patient Health Questionnaire 9 (PHQ9), Generalised Anxiety Disorder brief measure (GAD7), Work and Social Adjustment Scale, and a purpose created Wellbeing measure. Results from these measures stream the user into the most appropriate course for their presenting difficulties, focusing on depression, anxiety, and comorbid states. The app readministers these measures every two weeks to encourage self-monitoring of symptoms and improvements. The inclusion of standardised measures allows for easy clinical assessment and service evaluations of recovery rates. Users receive a course of CBT skills and techniques in the form of modular content. This content includes a combination of psychoeducation and skills acquisition through task-based practice. Users are encouraged to use the in-app tools, skills and audio files to help them practice their new skills. Occasional push notifications also promote engagement with CBT techniques. PILOT RESEARCH STUDY Having received ethical clearance from the HSRC, the Vimbo Pilot Study ran from February to June. This 12 week, mixed methodology study aimed to test the safety and efficacy of the Vimbo Therapeutics app. Qualitative data collection would allow for continued iterative design and improvement of the app and, crucially, explore users' experiences and perceptions of the treatment. The study recruited participants through SADAG support groups, call lines and campaigns on social media, including Facebook and Instagram. A total of 251 applicants volunteered. After screening for inclusion and exclusion criteria, 218 applicants were invited to participate. The study was open to South African residents over 18 with access to an android phone for the 12 week study period (it is now also available on Apple). The study was limited to those who could use the app in English. Exclusion criteria included presenting as a current risk of harm to self or others. This risk was measured using question 9 of the Patient Health Questionnaire. Recruitment and Retention Registered Participants: 114 Participant Withdrawals: 2 Retained past Data Point 2 (2 weeks): 79/112 or 70.53% RECOVERY RATES Only data from participants who met clinically significant levels of symptoms are included in the recovery data (we consider these to be the “Clinical Cohort”). Participants with sub-clinical symptom levels were provided a preventative Wellbeing course. Responses of over ten on either the PHQ9 or GAD7 and over 20 on the WSAS were considered clinically significant and assigned to the Clinical Cohort. We created the Vimbo Therapeutics app as a low-intensity treatment option for people struggling with mild to moderate symptoms of depression or anxiety in line with current research and best practice guidance. Clinical guidance, including NICE treatment guidelines, recommend a high- intensity treatment for those struggling with severe depression or anxiety. However, there is emerging data that low-intensity treatment options may create reliable improvement if not complete recovery in these cases. Considering the impact of timely treatment on preventing further deterioration of symptoms, we chose to include those presenting with severe symptom levels in the study and the recovery data. Participants met clinical recovery if they scored below clinical levels on all measures at their last completed data point within the 12 weeks. Though these are strict criteria for a pilot study, this allows for direct comparison with NHS services that use these guidelines to measure clinical recovery rates in their services. Below are some of our findings so far. Clinical Cohort Total participants: 71 Dropped out: 25 Retention: 65% Recovery % (excluding Severe): 18/34 or 52.9% Recovery % (including Severe): 19/46 or 41.3% For comparison, 2019-2020 data from the NHS IAPT services show recovery rates of 51.1% across its entire service (both low and high- intensity treatment). Silvercloud, a global leader in CCBT used by the NHS, reports recovery rates between 46 - 60% after three months of treatment. These services are still therapist led and supported compared to this research which offered no therapist input beyond the risk assessments completed with co-researchers where necessary. Unfortunately, we can’t be sure that there was no therapist input outside of the app since participants were not required to share this information. FUTURE DEVELOPMENTS Once complete, the researchers aim to publish their findings in a peer-reviewed journal. Vimbo Health. will further use the results to improve and develop the app. Future ambitions for in-app development include offering different language versions of the app, increased personalisation of the user experience and an increased number of interactive tools. Continued research and iterative technological development will strive to improve treatment outcomes and engagement. This pilot takes critical first steps to better understanding the local use case for Digital Health Technologies in the mental health sector. Further large scale, longitudinal studies are necessary to better assess the effectiveness of digital interventions for mental health in South Africa. Findings from this initial study offer strong support for app-based psychological interventions to bridge the ever- widening treatment gap.