New behavioral health apps are proliferating, fueled in part by a flood of venture capital. EAP professionals have mixed — but generally positive — feelings about the potential of apps to help employees and to expand the level of service that EAPs can provide. However, there also is concern about exaggerated claims being made as to the level of service an app can deliver. To get some insight on the topic, EBN recently spoke to Marina London, director of communications for the Employee Assistance Professionals Association (EAPA) and a blogger on EAP tech issues. Edited highlights of that conversation follow.

Employee Benefit News: To what extent has technology like “virtual therapy” become embedded in traditional EAP services versus traditional telephone-based interaction or actual face-to-face meetings?

Marina London: EAPs are receptive to it. In a recent National Behavioral Consortium survey on apps and e-health platforms, 60% of EAPs agreed that apps were very or extremely important in making interventions more available. Also, 30% of counselors at a large EAP indicated they are more likely to recommend an app this year than last. That’s enormous growth.

EBN: Can you put that in context?

London: I believe that about half of the EAPs being offered to Fortune 1000 companies are using some kind of face-to-face or phone-based consultancy. But over the past five years or so there has been a revolution with apps or virtual therapy.

EBN: How does virtual therapy work?

London: It involves using specialized goggles, and has been used extremely effectively in the treatment of substance use disorder. For example, somebody who is trying to deal with an alcohol issue puts on these goggles. Then they enter a scene where they are at a bar with all the sights and sounds that you have at a bar, and it helps them control triggering events.

EBN: That does sound useful. What are some other useful apps for EAP services?

London: In EAPs there’s a tradition of giving homework assignments to clients. The thinking is that you typically have only up to four sessions with a client. So to insure that employees get as much support as they need, EAP counselors are using apps that give homework assignments.
For example, if you went to use the EAP because you feel anxious all the time, the EAP counselor might give you an anxiety app as homework. The app categories of greatest interest are stress, cognitive behavioral therapy, depression, anxiety and addiction.

EBN: Isn’t cognitive behavioral therapy (CBT) too complicated to be reduced to an app?

London: There are some standard exercises that even people who take CBT, not through an EAP, can use. But to be clear, no app is a substitute for EAP counseling with the counselor. One of the major functions of EAPs is to perform an assessment and determine what level of care the person coming in to see that EAP counselor needs. Do they have a very specific finite issue that can be handled within the scope of the EAP? Or are they going to require referral to anything from an individual long-term therapist, to a treatment facility, to a hospital, etc.? That assessment function is not replaceable by an app.

EBN: Are there any apps that purport to provide that screening/diagnostic function?

London: No, although the U.S. Army is on the forefront of developing chatbots to do assessment, and one of the ones that they have developed is diagnose PTSD. This is counterintuitive. You would think that somebody who served in a combat zone would be unlikely to open up to a robot. But, in fact, the Army has found the opposite. It’s that because it’s a robot, they don’t feel judged. They actually speak much more openly with the chatbot and then, after that assessment takes place, they’re referred to an actual counselor.

EBN: So you view this as a positive development?

London: I think that we are at the absolute beginning of the development of these chatbots. PTSD is a very specific diagnosis, and it makes sense to me that you could develop a chatbot that applies to those specific criteria. But keep in mind that people often come into the EAP saying that they’re coming in for one thing, but actually something else completely different is going on.

EBN: So that would present a big challenge for a chatbot?

London: Yes. As an example, you could have a client who comes in and says, “I’m coming in because I fight all the time with my husband.” And when you explore it further, you find out that the arguments occur when both of the spouses have been drinking excessively. So then we’re not talking about a relationship issue, we’re talking about a substance issue. And there is not yet a chatbot even remotely capable of dealing with that kind of situation.

EBN: Are there any EAP-oriented apps out there that employers need to be particularly wary of?

London: EAP professionals are aware that there are vetted apps, and there are apps that have not been vetted. Unfortunately, that isn’t as well known within the general public. I think people are influenced by consumer advertising, which isn’t the same as looking at an app vetted by experts.

EBN: So it’s buyer beware, as with anything else?

London: What I’m incredibly concerned about at this point is there are apps that have been developed that claim they’ll fulfill all of your needs. Often these are developed by an IT business, not clinicians. The company might have a psychiatrist or two on their panel of experts, just to give it legitimacy, but that’s not enough. Some of these apps get funded with millions and millions of dollars from venture capital firms, and some of them are actually approaching employers directly and basically saying, “The only thing you need for your employees is [our product].” And if the person that they’re dealing with is not terribly knowledgeable, they’ll think, “Wow, that sounds great, I don’t have to pay for the EAP, I’ll just use this app.”

EBN: OK, let’s get back to the topic of technology that supports or extends EAP services…

London: It’s definitely an enhancement to be able to include apps as sort of one of the tools in your toolkit to help the employee. And some of it could reduce the need for other kinds of therapies that people were referred to in the past.

EBN: And technology can help with geographic barriers too, right?

London: Absolutely. Once I worked for an EAP that serviced a large corporation, and some of their plants were in the absolute middle of nowhere. The nearest therapist to have any kind of long-term therapy with would be a four-hour drive away. In those days we either had to say to them, “Well, you have to drive the four hours, or you’re not going to be able to get the kind of care that you need.” Now we do have apps which could perhaps tide them over or offer support in the absence of being referred to a human being. But this is a scenario involving someone who is more seriously ill and who goes to the EAP for an assessment, and the assessment is that they need ongoing therapy.

EBN: What EAP-related technology do you see on the horizon?

London: I mentioned chatbots and virtual therapy for very specific diagnoses — anxiety, for example, would be amazing. Let’s say you’re afraid of flying. To date, the main way fear of flying is treated is by sending people to a behavioral-based therapy and usually “graduating” is taking an actual flight. That’s extremely expensive. But if you could have a virtual reality fear-of-flying therapy, that would be incredible. People would put on virtual reality goggles, feel like they’re on a plane, and the therapist would be sitting next to them and talking them through their relaxation exercises. We’re not there yet, but we will be.That’s definitely on the horizon.

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