Personalised therapy could transform the way digital mental health services are delivered, believes the boss of SilverCloud.

CEO Ken Cahill’s company already offers more than 30 online therapy courses for a range of mental issues – ranging from depression and anxiety to stress and sleep deprivation – to more than 280,000 users on its digital platform.

But after announcing a research collaboration with Microsoft last week, SilverCloud is now exploring how to integrate artificial intelligence in order to tailor programmes specifically to the needs of individual users.

Speaking at the Microsoft Future Decoded conference in London on Wednesday 2 October, he said this would create “therapy for the 21st century” that doesn’t require traditional face-to-face sessions.

“Personalisation with delivery is key,” he added. “I think if the generic content is delivered to a generic population, the difficulty they’ll have there is low engagement and high dropout, resulting in poor clinical improvement.

“So we want to deliver something that is on time, in context and on demand, but not just something inferior [to face-to-face therapy] with user access – this is designed around outcomes.”

Why using cognitive behavioural therapy can help mental health issues

Boston-headquartered SilverCloud, founded in 2012, uses cognitive behavioural therapy (CBT) – the method deployed by most therapists – to help people manage a number of mental health issues.

According to the Get Self Help online therapy resource, CBT assesses how people think – cognitive – and what people do – behavioural.

It says that continuing to think and act in the same way leads to becoming trapped in a “vicious cycle”.

In turn, this maintains and contributes to conditions like depression and anxiety, which mental health charity Mind says affects one in four adults every year in the UK.

The Get Self Help website says: “Someone who’s depressed might wake up in the morning and think: ‘This is going to be another awful day’, ‘I’m going to mess up again’, or ‘What’s the point of anything?’, which will make them feel even more depressed (feelings), and may prompt them to pull the covers over their head and stay in bed (behaviours).

“It’s very likely that this will increase their negative thoughts, which in turn will increase the feelings of depression, and make them even less likely to get out of bed.”

By using the understanding that thoughts, actions and feelings are all directly connected like this, SilverCloud uses CBT to attempt to break this cycle by changing  the way people think and act in order to positively influence how they feel.

What is SilverCloud? Online therapy for the 21st century

SilverCloud digitises the CBT process by delivering the therapy online through self-help courses.

Users can access a course, which typically contains six or seven modules, anywhere via a computer or mobile device and complete at their own pace over an eight-week time span.

It features interactive tools designed to make the experience interesting and motivational, including videos, activities, quizzes, audio guides and a personal online journal.

Topics are chosen by a human therapist, who will often check in with a patient throughout the course.

Cahill, who co-founded the company, said: “We have over 30 programmes, ranging from the minimal or mild challenges around wellbeing, work-life balance and resilience, through to full interventional programmes for challenges like depression.

“This comes from over a decade of research into the area, looking at how we can deliver access to mental healthcare tools and techniques, and ensure that they’re effective in terms of engagement, dropout rates and clinical outcomes.

“We are also looking at the co-existence between chronic disease and mental health as well.

“We now deliver the platform to almost 300,000 users, and 65% of those users will achieve what will be classified as a significant improvement.”

On its website, SilverCloud says it removes many of the barriers preventing patients from accessing mental health services, including cost, access, clinical resources and stigma, enabling healthcare institutions to deliver clinically validated, digital therapeutic care that improves outcomes and lowers costs.

SilverCloud also claims its digital mental health platform is used across 75% of NHS mental health services in improving access to psychological therapies, and more than 250 organisations globally.

Cahill also acknowledged the fact SilverCloud is not a “pure digital solution”, because real therapists are also involved in the user journey.

He added: “Something we have built into SilverCloud is ensuring that there is a human in the loop to keep you engaged with the programme.

“Over your eight-to-10 week programme they’re guiding you through, they’re providing you with short, constant, motivational feedback.

“The core concept is that SilverCloud is a clinician-extender rather than a clinician-replacer.

“As one of the users on the platform said before, this is really therapy for the 21st century.”

How Microsoft and artificial intelligence can help SilverCloud take the next step forward

SilverCloud has now recognised a need to use data in order to personalise its service more effectively, focusing on the specific needs of individual users.

In a bid to achieve this, it has teamed up with Microsoft to explore how machine learning can be integrated into the platform.

SilverCloud also hopes access to the latest developments in machine learning and AI technology will give people earlier and easier access to therapy, further improving clinical outcomes and the effectiveness of its digitised therapy methods.

Dr Christopher Bishop, technical fellow and laboratory director at Microsoft Research Cambridge, the research subsidiary of the software giant, called SilverCloud a “remarkable” company.

“It’s early days of course, but we’ve already started to think about some of the ways in which we might use machine learning in this tremendous opportunity we have together,” he said.

“Some of the thoughts we’ve been having initially concerned stratification – the idea that, given SilverCloud’s very large cohort of users, we can start to use machine learning to look for patterns of groups of people who might respond in similar ways to particular intervention.”

He added that artificial intelligence can help both companies to really take the first steps towards true personalisation in a data-driven way, by looking at data from a large group and using it to deliver technologies that are tuned to the user.