Demand for mental health care increased during COVID-19. What didn’t? The supply of licensed mental healthcare workers.  

Unfortunately, the massive spike in demand for mental health services created by COVID-19 only exacerbated the gap in licensed human clinicians that existed well before the pandemic.

We’ve known these gaps in care have existed for decades. We’ve also known for nearly a decade that digital mental health care providers like Twill had to be part of the solution.  

What we were less sure about was the need to customize digital therapies to address specific issues and speak to specific audiences. If static, “one-size-fits all” digital therapies are effective, a handful of select interventions could service increases in demand.

But if personalization and context matter, then digital therapies need to be customized to address specific needs while still following a framework that has consistently delivered results.   

Creating Therapeutic Media

When I left my job as managing editor at the Oprah Winfrey Network in 2013 to lead content creation at Twill, I knew that the supply/demand gap in the mental health space was a growing problem across the globe, and I was excited by the potential to use prescriptive interaction and engagement with content to service unmet mental and physical health care needs.

I also knew it would be incredibly challenging.

Developing therapeutic media that meets clinical standards, and is also engaging, is a massively complex undertaking. One that I’ll confess I wasn’t totally ready for. 

The activities, games, videos, quizzes, journaling exercises, and A.I.-based dialogue we build on Twill leverage evidence-based methodologies for behavior change, and people have to complete clinically validated self-assessments so that our clinical team can measure the efficacy of the overall product.

Getting people to complete a clinically validated self-assessment on their own, on a smartphone, has been no easy feat for many companies in the digital health world. Getting people to engage with clinically therapeutic digital media (when their Facebook app is a swipe away) is an even greater challenge.  

From the beginning, our team at Twill took a painstakingly clinical approach to building digital therapies that emphasized usability and engagement without sacrificing efficacy.  

While we’ve seen the results of our work shine through in randomized controlled-trials and observational studies, we hadn’t had the opportunity to measure the impact of customization and personalization until the pandemic hit. 


Addressing Personal Behavioral Health Needs at Scale

When the lockdowns started in March of 2020, we knew we needed to jump into action. Our medical staff raised the early alarm bells that we all could hear—isolation, job loss, and living in a constant state of uncertainty could lead to spikes in anxiety and depression. 

But Twill was uniquely positioned to provide support, at scale, globally. 

In under 30 days, my team examined and rebuilt our product development processes and accelerated our production timelines, enabling us to design new, customized digital therapeutics and make them available in less than four weeks.

This was only possible because we already had a well-established core product suite and proven content framework. From that foundation we developed and deployed a new, foundational 4-week therapeutic for coping during a pandemic called “Managing Stress in Uncertain Times.” 

We then engaged our international network of translators and subject matter experts to localize this content, translating it into eight additional languages in under two months. 

Finally, we created and released additional personalized content to address the changing fears and worries people everywhere were experiencing.

Wave 2: Healthcare Worker Burnout, Teens in Crisis, and Racial Stress 

Different groups experienced unique challenges and stressors over the course of the pandemic. For example, healthcare workers were facing alarming levels of burnout that other workers could not relate to. And, quarantines and isolation had a very different impact on school-aged children than they did on adults. 

Similarly, the Black Lives Matter movement and the increases in Asian hate crimes had a different impact on Black and Asian communities than they had on other groups. 

The one thing we knew for sure  was that a “one-size-fits-all” digital therapy would have limitations. We believed that customizing our digital therapeutics was a critical step in addressing the specific needs of these often overlooked and underrepresented groups. 

Custom Digital Therapies in Action

For healthcare workers we partnered with the healthcare education company CaseNetwork to create a digital self-care program called Happify (Twill) CoreWellness. The product helps healthcare workers facing stress and burnout through a combination of cognitive behavioral therapy (CBT) and positive psychology delivered through audio, video, and other activity formats to help physicians and nurses increase resilience and reduce burnout.

To support teens, we created Twill for teens, the first multi-disciplinary digital mental health solution designed with this population in mind. We recruited actual teenagers to review every activity in the product, made clinical modifications to the privacy and safety protocols for the program, and created new content, like our teen-friendly meditations, with a goal of helping teens reduce stress and anxiety. 

For the Black community, we partnered with Dr. Clifton Berwise of the University of Delaware to create digital therapies focused on how to manage race-based stress and discrimination, while prioritizing self-care. We also teamed up with mindfulness teacher Liza Colpa to release meditations aimed at coping with racial trauma while celebrating Black identity.  

To support the Asian-American community, we collaborated with therapist Michelle Pow to develop custom therapies to address increased levels of fear and anxiety. We also hosted live events, including a free workshop on meditation and breathwork to promote healing, hosted by Korean-American meditation teacher Hannah Moon.

The Impact of Contextualizing Digital Health Therapeutic Media at Scale

Here’s what we learned: Timely, relevant content that is targeted to specific audiences, can break through age-old mental healthcare barriers by democratizing and personalizing access to relevant, clinical care.

Upon release of our new custom digital therapies, we saw monthly engagement increase 20 percent. 

We cut development time for our COVID-19-related content by 70 percent—shortening the time from almost three months to under three weeks. And, those changes we made to our processes were clearly impactful decisions that benefited our users, who needed support—fast.

Our experience over the past year highlights the value of continually innovating and personalizing digital therapeutic media. Customization and personalization is a must when it comes to supporting mental health care needs at scale.