Using technology to cope with stress-related mental health problems

Interview with Raffael Kalisch
An EU-funded research project, DynaMORE, has been developing an app that helps the user to prevent, or quickly recover from stress-related mental health problems. We speak with project coordinator and professor for Human Neuroimaging Raffael Kalisch of the Johannes Gutenberg University Medical Center, Mainz. With his team, he generated and validated the first ever computer (also called ‘in silico’) model of stress resilience.

Could you please describe the project in your own words?

Raffael Kalisch profileRaffael Kalisch: Stress-related disorders such as anxiety, depression or post-traumatic stress disorder pose a significant burden on individuals, the economy, and society in general.

The prevalence of these disorders has not decreased in the past decades, despite huge efforts that have been made in research on disease mechanisms and treatments. More recently, evidence has accumulated for an exacerbation of stress-related public health problems, in particular in young people.

The Covid-19 pandemic has further highlighted the societal relevance of stress-related burden. The overall aim of DynaMORE (Dynamic MOdelling of REsilience) is to improve the prevention of, or quick recovery from, stress-related mental health problems. DynaMORE’s approach is health- rather than disease-focussed, that is, we try to avoid mental health problems rather than trying to cure them after they have already developed into full-blown psychiatric diseases. Eventually, this will increase individual well-being and reduce healthcare demands and indirect economic costs.

DynaMORE pursues this goal by advancing the mathematical modelling of mental health, helping us also to deepen our scientific understanding; by generating and validating the first in-silico model of stress resilience; and by using it as a basis for developing an entirely new mobile Health (mHealth) product for the primary prevention of stress disorders, with great potential for commercial exploitation.

We anticipate that our solutions will be pandemic-proof and facilitate coping with future pandemics for individuals and for societies at large.

What were the main challenges?

Raffael Kalisch: Resilience – that is, staying mentally health despite adversity – is only partly determined by stable factors, such as genetics, and is therefore hard to predict. One can only say that someone is resilient if that person has successfully mastered a crisis. This positive outcome appears to depend on processes of learning and adaptation in which some people develop new strategies to better cope with the hardships they are confronted with.

Therefore, trying to measure resilience and identify resilience processes is like shoouting at a moving target. You need longitudinal observation of people under stress in which you repeatedly assess their mental health, their coping capacities and then apply complex mathematical modelling of the dynamic relationship between stressors, coping, and mental health. Only this allows you to understand how people adapt.

Such longitudinal frequent-monitoring studies are laborious and expensive. A European research landscape that permits such data collections –and to sustain them over much longer periods than feasible is something only being developed by DynaMORE. Another big challenge is how individually different these resilience processes are.

What are the main outcomes of your research project?

Raffael Kalisch: We have successfully developed a generic digital study paradigm and a modelling approach that allow us to conduct and analyse these longitudinal studies, which are already being adopted by other international research projects. We are now also integrating our smartphone-based digital interventions into the paradigm, in order to test their effects on mental health and to obtain more insights into resilience-promoting mechanisms.

Crucially, this includes the personalisation of applications depending on data we collect from our study participants. The whole set-up combining measurement, modelling, and personalised intervention is developing into an integrated tool for both basic resilience research and for the development and delivery of preventive interventions.

First results, including from data collections during the pandemic, point towards a key role for the positive appraisal of stressors in maintaining and regaining mental health. Many of our efforts now go into boosting this type of adaptive dealing with hardships.

What would be the impact of this project?

Raffael Kalisch: I think we are learning a lot about resilience mechanisms, but simultaneously we are heading for very efficient ways of promoting mental health that make use of the latest digital technologies, are scalable, cost-effective, and easily accessible, including in times of pandemics and in low-income populations.

They also have the advantage that they do not stop at national borders and can be applied anywhere. I am hoping that this will transform the way we are doing prevention and that our solutions will be adopted at large scale by our health care systems.

STOA online event: ‘Coping with the pandemic: Psychosocial consequences of the corona crisis’, Tuesday 25 January 2022 at 15:00h CET

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