[Music] isn't it amazing how a few words can almost immediately impact the way we see the world around us and change our perspectives I'd like to talk about one setting in which the words exchanged between two people can not only impact the way we think and how we feel but they can also relieve suffering and even save lives I work in the science of mental healthcare and I'm so excited to share with you some advances in technology and data science that I think are set to transform our understanding of how current treatments work but also
lay the foundations for a whole new generation of treatments you know it's so lovely to have an opportunity to share with you our work often when I meet people and mention that I'm focused on clinical depression their reaction will be something like my goodness is that the time and then they make a sharp exit but you know I've come to learn that about a third of those people who promptly vanish when I mentioned the word depression will later come back quietly and discreetly and tell me that their son or their daughter their husband or their
wife has been suffering terribly and they just want to know what the best options might be depression and anxiety are everywhere mostly invisible to us the statistics tell us that there probably isn't a family on the planet that goes unaffected by them but many people suffer in silence now that's partly because these conditions can be difficult to speak about but it's also because care is very hard to act do you know for example that in half the countries in the world there are fewer than four mental health workers for every hundred thousand people in the
population imagine the biggest football stadium that you've ever seen with a single person stood on the center spot responsible for the care of all those people watching the game this isn't only a problem in the developing nations right here in the United States in a rural area it can be practically impossible to access high-quality care in a timely way we need better options because these are serious conditions clinical depression that I'll talk about today is more than the experience of sadness that we all have from time to time a person with clinical depression can feel
sad or hopeless all the time day after day month after month year after year and there can be physical symptoms too people often feel constantly tired and I have disturbances in their sleep and their appetite a person with clinical depression can have every reason in the world to feel happy but fundamentally lose the ability to experience pleasure and joy so we have two key challenges the first is that we need to find new ways of giving people better access to treatment the second is that we need to make sure that the treatments that we offer
people are as effective as possible and technology and artificial intelligence may have a role to play so let's look at our current options if you're lucky enough to live here in the United States where you guys live or in the UK whereas you may be able to tell I live there are essentially two avenues of treatment available first is that you may be offered a drug based treatment or a medicine and the second is that you may be offered talking therapy or psychotherapy drug based treatments can be highly effective for some people even though we
still have a far from complete understanding of how these treatments work in the brain we do know the active ingredients in each pill we know the minimum dose that you need to take in order to see a benefit importantly we can study the chemistry in each pill and we know the chemistry will be the same in Tuesday's pill as it is in Friday's pill in Natick spill as it is in Nashville's pill one of the big challenges for the field in this area is to work out now that we have a range of treatments available
what works best for whom these dates are from a wonderful international group of scientists called Odyssey shows the most commonly prescribed antidepressant drug treatments and the circle shows the proportion of people that receive each of these treatments when they're first seeking help so a person with depression can be offered any one of a range of different treatments and it may well work first time but many people we've come to learn later go on to swap that medicine for a different type and the outer circle shows the second and third treatment that people will try so
although the trials of these drugs tell us what works on average for a group of people working out what might work for you or for you or for you can take several years of trial and error it's a bit like a roulette wheel it's nip wouldn't it be better if we could get that right first time so our other option is talking therapy and here in the United States there are hundreds of different forms of psychotherapy in common use it's really popular like with drugs for some people some of these treatments can be highly effective
and have a life-changing impact but over the last few years in fact the last few decades the recovery rates or outcomes associated with these treatments has largely stagnated and right now even in the most advanced mental health systems in the world with the most highly evidenced of these treatments if you end to treatment for depression with psychotherapy right now you have around a fifty percent chance of recovering during the course of your care I think we'd all probably agree that if we went to a hospital setting with a broken leg and we were told there's
a 50/50 chance of our leg being fixed that wouldn't somehow seem acceptable to us put it and I think we can challenge ourselves to have higher expectations in mental healthcare - so what is it that's holding us back well one of the key reasons is that we just don't understand enough about the active ingredients or core mechanisms of effective psychotherapy in cancer we know that the core mechanisms of treatment is the destruction of cells in diabetes we know that the core components or essential ingredient of treatment is the control of blood sugar but in psychotherapy
the active ingredients or core components remain something of a mystery therapists will say and do all sorts of different things but we just don't know which of those things really matter in cancer and diabetes it's also much easier to learn what works for whom because we routinely measure the effect of treatment in clinical practice but unfortunately with psychotherapy in the vast majority of settings we don't measure outcome but when we do it can be a complete game-changer let me give you some examples of how measurement and data may hold the keys to progress for the
last 10 years in the UK in England anybody entering treatment for depression with psychotherapy has been asked to record the frequency of all the symptoms that they're experiencing they use questionnaire based rating scales that can be charted like this if you experience all the main symptoms of depression every day your chart would look full like this it's full of symptoms if you're not experiencing any symptoms of depression your chart would look like this empty of symptoms which is of course what we would like now we've come to learn that recording and measuring the effect of
treatment is useful to therapists and patients because they can track progress as as treatment progresses but we can also look at all the data together carefully and purposefully to make new discoveries we've learned for example that although everybody's experiencing depression is slightly different there seemed to be some common types or subtypes one very large group of patients experienced depression primarily as changes in the way that they see themselves and the world around them they might feel constantly worthless or that life is hopeless another large group of patients experience depression quite differently their experience is dominated
by feeling constantly tired having disturbed sleep and appetite and other physiological symptoms we're really excited about this because we think that tailoring treatment in a way that recognizes these differences may lead to significantly better outcomes for patients depression may not even be one condition at all and like in cancer the era of one-size-fits-all treatment for depression may just need to come to an end so better matchmaking between a patient and a particular form of treatment may take us forward but how could we put the psychotherapy itself under the microscope just like we might a to
find those active ingredients well since the advent of advanced computational techniques often referred to as artificial intelligence we have for the first time being able to forensic ly analyze the actual content of therapy even down to the level of individual words used by the therapists you can think of how Google Translate works Google's AI based systems have been able to read text in one language and automatically recode that same message into a different language say English to French I just wish that technology existed when I was learning French at school we use the same technology
it's called deep neural networks to take the language that's expressed in therapy and to translate that into a simple therapy barcode or fingerprint that we can analyze readily what you can see here in this line is a one-hour session of therapy between a therapist and a patient and the colors signify different types of dialogue that are occurring moment by moment through the session as interpreted by the artificial intelligence at the beginning of the session the computer detects our greeting the therapist says hello then for a few minutes after that in these green elements show us
that the computer is detecting chitchat or simple non therapeutic language if it were here in Boston it might be about the traffic about eight minutes into the session we see these pink elements that's where the computer has detected that the therapist is starting to use structured clinical language and a range here of therapeutic techniques in this particular session it detects that the therapist is using something called cognitive react rebuke that therapists use to help patients understand that they themselves may not be the root cause of all the difficulties they are ex Aaron Singh about 40
minutes in we see more chitchat until the end of the session when the therapist says goodbye after each session the patient reports the frequency of their symptoms using those questionnaire based rating scales and that enables us to study the relationship between exactly what's happening in the therapy session with subsequent improvement in symptoms we've now studied over 20,000,000 therapy language events and we're starting to see some really important patterns a simple example is that we've found at least four this form of therapy that effective care seems to be surprisingly businesslike therapists set an agenda for every
session they have goals for the time that they spend with patients they review homework tasks that they've agreed with the patient they use an abundance of these pink structured clinical techniques and we don't see much chitchat at all now I've chosen a good therapy session to show you here but more often than we would like it doesn't look like that here's another therapy session perhaps you can already see the difference this session is full of chit chat with very little actual therapeutic content happening there aren't really any active ingredients in this pill so we're using
this technology now to provide immediate feedback to clinicians so that they can reflect on their practice and we give them pointers as to how they can improve their care and it's data driven approaches like this that are enabling us to really take the fight to depression we run one of the largest psychotherapy services in the UK and over the last few years using these data driven approaches our outcomes or recovery rates have finally started to improve year after year we see that the proportion of patients who make that full recovery during the course of the
care has been improving what this means is that for every hundred thousand people can print completing treatment another eight to ten thousand people will get well who otherwise might not have we're really finally moving beyond the stagnation of the last three decades for an individual patient this can make all the difference here's a quote from one of our patients my therapist took me on after I'd been unsuccessful with previous treatments and when I'd been struggling for two years his words made my mind let go of unhelpful ideas and he even made himself available around my
schedule even at 10 p.m. now you may have in your mind that therapy necessarily involves two people together face-to-face in a room but it may surprise you to learn that all of the 250,000 hours of therapy that we've delivered over time period happened entirely remotely everything over the internet and actually everything in writing it's a bit like a whatsapp experience the therapist and the patient never meet they never even speak on the telephone so it's talk therapy just without any talking that means that we can demonstrate that we are able to reach people at a
distance using computing but by using computing in the interaction between clinicians and patients we can also aggregate the data carefully and purposefully it will fuel the discovery of new and better treatments the patient goes on the only negative about the experience is that I never got to meet the person who has such an impact on my life and to say thank you in person an invisible hero but what about those areas of the world where there are no therapists well we now believe that as well as using these sequence decoded therapy data to train clinicians
we can also use them to Train artificial intelligence based computer systems to deliver some of the active or essential ingredients of treatment without humans involved for example using voice based computing this isn't science fiction we are building these technologies right now and they will enter clinical trials soon we believe in a world where no one is held back by mental illness a world image which when anybody takes that brave step to seek help help is available to them regardless of the location or how much money they have a world in which treatments work first time
every time and I believe that by harnessing the power of data artificial intelligence and other technologies that vision can soon become a reality thank you [Applause] [Music]
