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AAAS Fellow Ricardo Muñoz Launches First “Digital Apothecary” for Online Mental Health Interventions

Ricardo F. Muñoz
Ricardo F. Muñoz. Credit: Susan Merrell, University of California, San Francisco.

Over the past five decades, AAAS Member Ricardo Muñoz has been harnessing the latest technological means of delivering mental health interventions to as many people as possible. Earlier in his career, he focused on interventions using books, television, and mailed brochures and audio cassettes to support others’ mental health, but now he is set on the ultimate medium – the internet.

As a psychologist and researcher, Muñoz has done numerous studies on the intersection of technology and mental health interventions. He is particularly optimistic that digital interventions could improve the lives of a substantial number of people worldwide who are at risk for depression. His brainchild project involves providing people with access to evidence-based digital interventions, regardless of language, literacy, income and other barriers through a variety of channels; i.e. text messaging, a website, even an app. For Muñoz, the opportunities are vast. 

“When I began working on the internet in the 1990s, we could only reach probably 3 percent of the population of the world via the web. Now, we can reach 60 plus percent of the world’s population. It’s amazing how much that has changed over the years, and we need take advantage of that,” says Muñoz. “So that’s part of where my contributions have been to science.”

It was in the 1970s while working on his B.A. at Stanford and later, his Ph.D. at the University of Oregon, that Muñoz first became enamoured with a new mental health method that was gaining traction at the time, known as cognitive behavioral therapy. This branch of therapy focuses on the psychological connections between the way a person thinks, behaves and feels. At the time, there was evidence emerging that this approach could be used to treat various mental health issues, including depression.

When people are depressed, there’s a tendency for negative thoughts, emotions and behaviors to feed into one another, impairing the quality of the person’s life, says Muñoz. Cognitive behavioral therapy helps reverse this negative feedback loop, through empowering techniques to create thoughts, feelings and behaviors that improve one’s health.

Over the years, Muñoz completed numerous studies exploring ways that cognitive behavioral interventions could be used to treat – and even prevent – depression and other mental health disorders. But as the internet made its debut in the early 1990s, Muñoz was curious to know if online interventions using cognitive behavioral methods could be effective for improving health.  

To explore this possibility, in the late 1990s he conducted a randomized controlled study designed to help Spanish- and English-speaking people quit smoking. Earlier randomized controlled trials had shown that the nicotine patch yielded 14% to 22% quit rates.  The online study conducted by Muñoz and colleagues yielded 20% quit rates, showing that an online intervention could “match the patch,” he says. Since then, more data have been published supporting the efficacy of online intervention for mental health, showing that it can be as effective as face-to-face therapy in some cases.

Online interventions offer several advantages. As Muñoz notes, study participants have traditionally stopped receiving an intervention upon the completion of a trial.  But after his smoking study, which included 1,000 participants from 68 countries ended more than two decades ago, he simply left the website up and running. An astonishing 34,584 people from over 168 countries were able to access the smoking cessation interventions over the subsequent years. 

Of course, several limitations to the online approach remain. Muñoz, who is originally from Peru, notes that the number of online interventions (as well as therapists) is limited for Spanish-speaking people. Literacy may also be a barrier, underscoring the need for video-based interventions. What’s more, 40 percent of the world still lack access to the internet.  

To make online interventions more accessible, Muñoz has advocated for the creation of digital apothecaries.” These would be online portals hosting evidence-based digital interventions for many health conditions and in many languages.

He also envisions hospitals and clinics throughout the world establishing “internet intervention rooms” next to their pharmacies, where evidence-based mental health interventions would be offered to people who lack internet access. These interventions could be offered in different languages, and also include video interventions for those who cannot read.

Muñoz was recruited by Palo Alto University to establish the Institute for International Internet Interventions for Health (i4Health). The university has since launched Muñoz’s “Silicon Valley’s Digital Apothecary” on April 15, in response to the COVID-19 pandemic.

“When something like COVID-19 happens, which places a tremendous limit on our freedom, it’s really important to try and focus on the things that we can control,” he says. “And the things that we can control include what’s going on in our mind and what we do on a day to day basis – even with the limits of physical isolation.”

Challenges of COVID-19 aside, Muñoz remains passionate about his work and his vision, 50 years after he chose to study psychology. “Half a century is a long time to be in a discipline. I feel so enthusiastic about all of the possibilities in psychology, probably even more than when I just started,” he says.

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Michelle Hampson