Digital Mental Health Use and the Role of Paraprofessionals: A Conversation with Dr. Bethany Teachman

 Interviewed By Megyn Jasman

Q: Dr. Teachman, you have been involved in mental health and evidence-based skill literature for a while. What made you interested in digital mental health interventions and the role of technology in mental health care? 

I am not someone who you might have predicted would get involved in digital mental health interventions – I am routinely a late adopter of new technologies and have little technical background. However, over the years, I became increasingly distressed at the many barriers to people accessing good-quality, in-person mental health care, including high costs, lack of trained providers, long waitlists, stigma, and the logistical challenges of getting childcare, time off work, and transportation to get to appointments. These barriers, paired with the tendency of most anxious individuals to avoid the things that make them anxious (including coming in for help and facing their fears), have resulted in a broken system where the large majority of people do not get the care they need. In particular, individuals with anxiety routinely suffer for decades before getting treatment. This dismal state motivated our team to consider other ways to increase access to care and bring interventions to people when and where they need them most – digital health care approaches along with mentors and paraprofessionals have great potential to improve access to care.

Q: Your paper on supportive accountability for an online anxiety intervention (link below) had mixed findings. What suggestions do you have for those trying to support the administration of digital mental health interventions through supportive accountability? 

I expect it is going to be very important not to assume a one-size-fits-all model. Just as we want to allow personalization for many aspects of digital mental health interventions, we also likely need to increase the user’s choice about who provides support (e.g., their friend, family member, natural or formal mentor, or a fellow user), how that support is provided (e.g., by phone, text, email, etc.), on what schedule, and which potential barriers to engagement and adherence are addressed during coaching or other supportive interactions. I think allowing this choice is likely to be especially important for socially anxious populations (a group our team works with a lot) because of their tendency toward avoidance of novel social interactions.

Q: How can mentors and paraprofessionals support digital mental health use? Do you see the field of paraprofessional work shifting to involve similar forms of support for evidence-based care? 

This is an exciting time for researchers and the field as we work to determine how to optimally support users as they try digital mental health interventions. Given high rates of dropout, a key role is likely to be helping users whose motivation is lagging by reinforcing continued use of the program, and both normalizing users’ ambivalence about making hard changes and helping people not get stuck in that ambivalence and the status quo. Another key role is guiding users to recognize how the program can help them and be applied in their daily lives. Developing a new skill has limited benefit if you’re not sure when and how to apply the skill. Mentors and paraprofessionals can help make those connections. They can also help celebrate steps forward, which both increases motivation to take more steps forward, and is likely important to support users’ identity shifts – it can be hard when people initially change their behavior (such as reducing how often they avoid social situations) to integrate those changes into how they view themselves. We want users to start seeing themselves as someone who can handle parties and speak in class now but that shift isn’t always automatic. Part of how we understand ourselves is in relation to others, and mentors and paraprofessionals can help users recognize and internalize the changes they are making.

Link to Supportive Accountability Article: