Lee Ritterband, Jean and Ronald Butcher Eminent Scholars Professor and director of the Center for Behavioral Health & Technology, says helping people overcome severe insomnia is “incredibly gratifying.” (Photo by Dan Addison, University Communications)
A fifth-grade school teacher is at her wits’ end.
Most nights it takes the woman – who is in her 40s – at least two hours to fall asleep. Almost every night, she wakes up at 3 a.m., then can’t get back to sleep for another two hours.
She has tried everything she can think of – a warm bath, reading before bed, leaving the television on – to no avail. Her husband has been supportive, but now feels helpless and is starting to lose patience.
This woman exemplifies the estimated 30 million people in the U.S. suffering from chronic insomnia.
It was with this in mind that University of Virginia School of Medicine professor Lee Ritterband created SHUTi (Sleep Healthy Using the Internet) – a digital therapeutic that uses cutting-edge technology to administer cognitive behavioral therapy for people suffering from insomnia.
In more than two dozen clinical trials – many involving the likes of the fifth-grade school teacher – SHUTi has reduced insomnia severity by an amount comparable to face-to-face therapy. Studies in the U.S., Australia, Norway and Denmark have also shown that SHUTi users experience less depression, anxiety, fatigue and other co-occurring conditions.
SHUTi is just one of many digital therapeutics Ritterband and his team have created and tested. In recognition of the impact of his innovative solutions, the University of Virginia Licensing & Ventures Group has named Ritterband the 2019 Innovator of the Year.
“We are thrilled to honor Lee Ritterband for his work pioneering the integration of digital solutions for patients living with a variety of issues, including insomnia, cancer, diabetes, and substance abuse, just to name a few,” says Michael Straightiff, executive director of the UVA Licensing & Ventures Group. “Ritterband sits firmly at the helm of this emerging field and his efforts to make these treatments available on a mass scale through commercialization stand to significantly reduce the overall cost of behavioral health care.”
Most of the interventions created by Ritterband and his team are fully automated programs that don’t require regular doctor’s appointments. This allows for greater ability to scale and disseminate the programs because the only necessity is an internet connection.
“We work hard to automate as much of the intervention as we possibly can,” Ritterband said. “The minute we add a person to the mix is the minute we dramatically reduce the ability to deploy these programs on a large scale.”
Of course, some disorders need an involved clinician, but Ritterband has shown that for many people, an automated program works incredibly well. SHUTi is no exception. Users log onto the web-based treatment platform through either their computer or mobile device. After creating a sleep diary and answering a number of questions pertaining to their sleep habits, SHUTi’s proprietary algorithms determine a patient’s ideal sleep window.
Users continue to enter their sleep diaries over time which further tailors the program to the individual users’ needs. The program is also filled with content, animations, interactions and videos, all to provide the treatment in an engaging and effective way.
Initially, Ritterband said users have some rough nights as they try to adjust to the new sleep window. But in the end, if they stick with the therapy, they can break their old habits and start to get better sleep. He came up with the idea when he was doing clinical work at UVA and realized the need to make sleep therapies more widely available.
“Everything just kind of exploded from there,” he said.
Ritterband’s mission is to increase access to effective and affordable behavioral health care.
“It’s very simple,” Ritterband said. “It’s basically taking what we do as clinicians and automating it and making it available for the public. The UVA Licensing & Ventures Group has been a tremendous partner in helping make that happen.”
Digital therapeutics are a new subsection of digital health that aim to deliver therapies through the internet or mobile devices.
According to Joseph Jennings, who co-founded BeHealth Solutions with Ritterband and former UVA faculty member Frances Thorndike, independent researchers are predicting the global digital therapeutics market will reach $9 billion by 2025, up from about $2 billion in 2017.
Jennings said the estimated 30 million people in the U.S. suffering from chronic insomnia carries an economic burden of more than $100 billion per year.
“SHUTi is a great innovation because it provides a highly effective solution for a huge problem,” Jennings said. “Very few people have access to traditional therapy because there are fewer than 700 providers of the therapy available in the U.S. to serve the 30 million insomnia sufferers, and those providers are typically concentrated in high population areas.”
Ritterband, who collaborated with Thorndike on the development of SHUTi, said it’s been “incredibly gratifying” to see his idea help so many people.
“I’m a clinical psychologist and one of the things I was trained to do was help people,” he said. “This allowed me to do it in a much broader way. Instead of the hundreds of people we might be able to help in a clinic, we can scale these platforms to help thousands, tens of thousands – or maybe millions at some point – by making these kinds of interventions available. They’re lower cost, they’re more accessible, they’re empirically validated.”
In addition to his recent work with SHUTi, Ritterband and the Center for Behavioral Health and Technology support the development of other internet interventions including:
• CARRII, to reduce alcohol-exposed pregnancy risk;
• UCanPoopToo, to help families of children with encopresis;
• mySmartSkin, to increase skin self-examination and sun protection behaviors among patients with melanoma;
• BGATHome, to help diabetes patients recognize and anticipate extreme blood glucose fluctuations;
• iSHIFTup, to prevent pressure ulcers in adults with spinal cord injury.
“We can provide treatments to people who might not otherwise be able to get them.”
Ritterband said he wouldn’t have been able to accomplish what he has without collaboration from his many colleagues and multi-disciplinary team at UVA, support of the School of Medicine, the Department of Psychiatry and Neurobehavioral Sciences, and strategic partners like the Licensing & Ventures Group.
“They’ve been amazingly supportive,” he said. “I have colleagues at other places where they get ‘No’s’ a lot. Here, I don’t get that. I get, ‘How can we make this work?’ People are really excited about what we’re doing and they want to help us find a way to do it.”
The UVA Licensing & Ventures Group will celebrate Ritterband at the 2019 Innovator of the Year Award Ceremony in the Rotunda Dome Rome on Feb. 21 at 5 p.m. The event is free and open to the public, though registration is required. Register here.