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3 Min Read

How patients type and what this tells us about how they engage with digital therapy.

15 Dec 2022
Daniella Quinn and Dr Michael Ewbank

There is a common belief that therapy involves being offered words and advice that will make you feel better; that the clinician is the one with all the answers while the role of the patient is passive – they just have to simply turn up and listen. This impression likely comes from experiences of other healthcare services, (visiting a doctor, for example) where a diagnosis is delivered along with recommendations, and treatment is given to the patient. With psychotherapies such as Cognitive Behavioural Therapy (CBT), however, findings suggest that treatment is an active learning process, which requires commitment and action from the patient.

What have we found?

In the UK, ieso provides one-to-one typed CBT sessions, for moderate to severe mood and anxiety disorders. Our own research indicates the importance of the patient being an active participant in their own treatment. Through our analysis of over 26,000 cases, we have found that there is a statistically significant relationship between how patients type during their sessions and how well they do in therapy. By looking at the number of words typed and how quickly patients type a response to their clinician, we found that those who write more words per second, that is, typing more words and typing more quickly, are less likely to drop out before they have finished treatment. These patients are also more likely to have improved by the end of treatment. We also found that this is important from the very start of treatment: the more patients type and the more quickly they type in their first session, the more likely they are to engage with therapy, returning for a second typed-therapy session. It’s possible that someone who types faster is simply more at ease with using technology. We know younger people tend to be quicker at navigating their devices than older generations, for example. What we’ve found is that the relationship between typing speed and therapy outcomes remained present even when controlling for variables that we know affect typing speed and volume (such as age and severity of depression, for example).

What are these measures telling us?

This isn’t to say that the key to getting better is simply typing more and typing more quickly. The reason why some patients are behaving this way is probably telling us something about what’s going on at their end. It's likely that a patient typing more and more quickly is indicative that they are more actively participating in the therapeutic process than one that isn’t. In other words, they may be applying more effort and focus into their treatment and are more likely to be free from distractions and therefore, more focused on responding to the clinician. Rather than being passive, these patients appear to be actively contributing to the session - perhaps they are sharing more information during sessions, which can help clinicians decide on the best course of treatment. Ultimately, therapy is a collaboration between a clinician and a patient and requires involvement from both sides: the clinician works with a patient to help change their thoughts, feelings, and behaviours that underlie their problem, so that the patient gets better. How patients type likely reflects their active input and commitment to this collaboration.

What role can digital healthcare companies play in encouraging patients to be active participants in their treatment?

What this research shows is that because digital healthcare enables the collection of data, companies have both the opportunity and the responsibility for using it to encourage, support, and improve patient engagement- not simply turning-up, but actively being involved in the treatment. We must responsibly use the analysis of that data to make platforms easier to use and to find ways to encourage patients to become active participants in their treatment. By implementing these real-world insights into our platform, we aim to help make therapy more engaging, and in turn more effective, for everyone.

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Daniella Quinn and Dr Michael Ewbank
In our latest expert article, Daniella Quinn and Dr Michael Ewbank explain how we’ve been analysing the way patients type and what it can tell us about how they engage with digital therapy