Anxiety rates are soaring during the COVID-19 pandemic.
The share of adults reporting anxiety or depression has increased since the start of the coronavirus pandemic, with four in ten adults age 18 and older (40%) reporting symptoms of anxiety or depression in July, according to research from Kaiser Family Foundation (KFF).
Now, a new study indicates that on-demand mental healthcare that includes virtual services can be effective in reducing the symptoms of anxiety, which is an extremely prevalent condition, but has received notably less attention than other mental health conditions from research, clinical, and public health perspectives.
The study published Monday in The Journal of Medical Internet Research (JMIR) found that behavioral health coaching can be just as effective as clinical tele-mental healthcare services for anxiety reduction, said Dr. Dana Udall, chief clinical officer at Ginger.
"Research suggests that therapy and psychiatry are effective for anxiety reduction, and behavioral health coaching by itself can be effective in reducing anxiety. It’s the combination of both that was the most effective in reducing anxiety symptoms even more than one of those modalities by itself," Udall said in an exclusive interview with Fierce Healthcare about the study.
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San Francisco-based Ginger delivers evidence-based behavioral health coaching, therapy, and psychiatry right from a smartphone. In August, the company raised $50 million in a Series D funding round led by Advance Venture Partners and Bessemer Venture Partners. Cigna Ventures and existing investor Jeff Weiner, executive chairman of LinkedIn, as well as Kaiser Permanente Ventures also participated in the round.
Ginger launched an observational study of 1,611 individuals to compare anxiety outcomes among individuals engaged in three distinct modalities of care: text-based, behavioral health coaching services; telemental health services (teletherapy and remote medication management), and a team-based model comprised of both modalities.
A virtual, team-based approach comprised of behavioral health coaching and clinical telemental health services is the most effective approach, the study found. And, for certain individuals, behavioral health coaching services can be just as effective as clinical telemental health services in improving symptoms of anxiety.
Participants were typically treated for 8-12 weeks, during which their anxiety was assessed using the Generalized Anxiety Disorder (GAD) questionnaire upon beginning and throughout treatment.
The likelihood of a reduction in anxiety symptoms was highest for individuals in the team-based model: about 60% of individuals in this group experienced a reduction in their anxiety symptoms compared to 50% in the coaching-only and clinical-only cohorts. This increased likelihood of symptom improvement for the collaborative group was consistent across all levels of baseline symptom severity (mild, moderate, and severe), according to the study.
“Anxiety disorders are the most common mental health conditions in the U.S., and the COVID-19 pandemic has only exacerbated the situation. In July 2020, about 35% of U.S. adults reported experiencing symptoms of anxiety," said Patricia Areán, Ph.D., a professor in the UW Department of Psychiatry and Behavioral Sciences and a licensed clinical psychologist.
"People today urgently need and deserve high-quality mental healthcare that can be quickly deployed at scale; a virtual, team-based care model does just that," Areán said.
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Ginger says it has built one of the world’s largest mental health data sets through its Mood Matters study, conducting research with eight of the top ten academic medical centers in the U.S., and partnering with over 40 medical institutions nationwide. These programs, as well as Ginger’s internal studies and data-driven quality assurance program, continually inform the development of Ginger’s on-demand mental health system.
The company was founded in 2011 as a spinout from the MIT Media Lab to provide on-demand mental health services. The company evolved to become a virtual behavioral health care system and offers full-service online and app-based mental health services.
The latest published research supports Ginger's model of integrating behavioral health coaching into clinical services, Udall said. The research shows that "innovative, highly-scalable modalities of care, such as text-based behavioral health coaching, are effective—especially when delivered in a virtual team-based care model such as Ginger's on-demand mental health system," she said.
Behavioral health coaching takes an active, goal-oriented approach to address a wide array of sub-acute challenges, from sleep to mood and relationships, according to the company. Ginger's behavioral health coaches help members navigate their care experience and find the right level of care.
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Ginger developed a platform that enables behavioral health coaches to be available to provide support 24/7 via text-based chat. Coaching meets the needs of approximately 85-90% of Ginger users, and when a member needs additional support, a licensed therapist or psychiatrist can be added to their care team.
Behavioral health coaching helps to address the mismatch between the supply and demand for mental health care services, Udall said, especially as the COVID-19 pandemic increases mental health issues.
"We need behavioral health coaching a way to scale care. Not everyone necessarily needs therapy or psychiatry. Behavioral health coaching can be a more cost-effective intervention and provides support in between clinical sessions and clinical sessions can be reserved for when they are truly needed," she said.
The startup is expanding its services into adolescent care and also will provide mental health care in Spanish, Udall said.
Ginger’s recent findings in anxiety mirror results from its previous observational study that investigated the effectiveness of its on-demand approach in reducing symptoms of depression. In that study, 1,662 Ginger members—93% of whom engaged in coaching alone or coaching plus clinical services—showed significant decreases in the proportion of individuals who experienced symptoms more than half the time. Results were published in JMIR in June.