Can Digital Mental Health Tools Save Psychology?

After decades of research on mental health treatments for conditions ranging from schizophrenia to depression, from anxiety to autism, our track record remains poor. For example, anxiety disorders alone will affect over 90 million people in the lifetime – in the U.S. alone. That’s approaching a third of our population. Yet, only a small fraction of us receive effective, long-lasting treatment. Thus, while we mental health professionals do much good and have some excellent, evidence-based treatments, we also know that, on balance, we are far from doing enough. We are failing.

I believe that there are many reasons for this failure. Psychological disorders are incredibly complex, with diverse and wide-ranging causes and manifestations that vary extremely from person to person. So we have an unbelievably tough problem to solve. But in addition, I believe that there is a two-part “recipe for disaster” that has put up additional barriers to the development of effective treatments:

  1. The stigma of mental illness
  2. Professionals minimize the importance of making treatments acceptable to the individual

The Stigma of Mental Illness

If you type “stigma definition” into Google, here is what comes up:

noun: stigma; plural noun: stigmata; plural noun: stigmas

  1. a mark of disgrace associated with a particular circumstance, quality, or person.

“the stigma of mental disorder”

synonyms: shamedisgracedishonorignominyopprobriumhumiliation, (bad) reputation
antonyms: honorcredit

It is no coincidence that mental illness is the paradigmatic example given by the dictionary. It is one of the most pervasive and persistent of the social stigmas. If we think about other sources of stigma – like the stigma suffered by those diagnosed with HIV/AIDS in the 80’s and 90’s and beyond – the stigma of mental illness is especially striking because mental illness is not contagious. But we fear it as if it were. The mentally ill are NOT more likely to commit violence, and yet, this is what many people fear. Take the media frenzy following the Sandy Hook Elementary School tragedy as an example of this type of assumption.

As long as mental illness remains a sign of disgrace and dishonor, people will avoid seeking professional help because it makes them feel broken – perhaps beyond repair.

Professionals Minimize the Importance of Making Treatments Acceptable to the Individual

There is another issue exacerbating the barrier represented by the stigma of mental illness. This barrier is that we scientists and practitioners, in our education, are socialized away from figuring out how to provide individuals with services they need in a way that they want – something that is obvious to any product- or service-oriented industry. Instead, we are taught to believe that we know best because we use the tools of science to develop the most efficacious treatments. The implicit narrative is: “We are the experts! We have figured out the best “medicine” for you, now take it!” This arrogance often keeps us from seeing that if we develop treatments that are too onerous or if treatments are embedded in a culture of disgrace and stigma, then we have failed to solve the problem. We have failed to meet “consumer needs.”

This is of course an overstatement and many mental health professionals actively fight against these attitudes. But there is a grain of truth here. Anyone on either side of the mental health fence – both professionals and patients – is familiar with this feeling, whether it’s acknowledged or swept under the rug.

How Digital Mental Health Tools Can Disrupt Stigma and Increase Acceptability of Treatmentspersonal zen achievement

In addition to breaking down barriers to effective, affordable, and accessible mental health treatment, I believe that digital – in particular mobile – mental health tools can be harnessed to have profound and lasting disruptive effects on the stigma of mental illness and on our failure to make acceptability of treatments a top priority. Here are five ways I believe digital mental health tools might just save Psychology:

If treatments are administered on a device, they are normalized 

If we are successful in attempts to embed evidence-based treatments into mobile and gamified formats, I believe we can profoundly reduce the experience of and appearance of stigma. Devices have become our filters of information, our gateways to the world, sources of fun, and our hubs of connection. The actions we perform on our devices, by association, feel more “normal,” more connected to every aspect of our lives and to others. This creates a process of validation rather than shaming. By putting mental health treatments on devices, we might just be normalizing these treatments and creating positive emotional contagion – treatments become “good” by association with the devices we love. And if we gamify interventions, these effects could be strengthened even further.

Self-curating our mental health

With digital mental health tools, accessibility is exponentially increased. For example, with mobile mental health apps, you have affordable help “in the palm of your hand.” This ability to curate creates a sense of empowerment. This is “self-help” in a very real sense. With this high level of accessibility and empowerment, many of us will avail ourselves of interventions to reduce negative experiences and states.  In addition, with the proliferation of digital tools to PROMOTE positive outcomes and to reach our fullest potential, we may find on the societal level that this positive focus is just as helpful – if not more so – as the focus on preventing negative outcomes. This attitude of promoting the positive is an excellent antidote to stigma. Who couldn’t benefit from promoting more of what is positive about oneself and how one lives life?

Digital health technology provides powerful platforms for community building

This is readily apparent. With greater community building comes a sense of belonging and a reduction of isolation. But digital community building also provides opportunities for effective advocacy. Of course, many such groups exist, but excellent digital mental health tools with a social media component could accelerate the creation of such systems, leveraging all the power of an individual’s full social network.

The profit motive will fuel innovation and valuing of consumer perspectives

Once interventions enter the digital and mobile technology world, the accompanying consumer focus (read $$$) will force the development of consumer-oriented products. Users have power in this domain. So, if interventions are onerous, boring, or non-intuitive, people will simply not use them. User stats will do the rest – no one will put resources into a product that people won’t use. Better ones WILL be developed.

Digital mental health increases opportunities for gamification

The gamification of mental health is beginning. At this point, we are taking baby steps, since we have an absence of a strong empirical base; in other words, there is precious little research showing that computerized games have a direct, positive influence on mental illness or on the promotion of mental wellness. But we are only in the earliest, exciting stages of this revolution. As I’ve written elsewhere, I don’t think all treatments should be computerized or gamified, nor do I think face-to-face therapy is obsolete – far from it. But I believe that if fun can be combined with powerful treatment technologies, then we can in a single step make profound progress in erasing the stigma of mental illness and creating treatments that people will truly want to use.

Cropping Out the Sadness

An interesting thought piece by Glynnis MacNicol on what might happen when the life you are living online diverges sharply from your real life.  Ms. MacNicol alludes to some of the potential costs, which I imagine are indeed a risk. At the same time, I can’t help but wonder if we could use technology to create a “highlight-reel self” not to hide or be in denial, but to forge a new story of our lives in an attempt to break out of old, stuck ways of feeling about ourselves. It could be an act of “re-visioning” if we do it right.

 

 

Is Your Child Using Devices Too Much? Apply the Delight Principle

Many of us parents worry about the potential negative effects of technology – particularly mobile technology – on our children. But we have precious little science out there that can help us figure out the costs and benefits, risks and returns. Heck, we’ve had television sets in our homes for over 80 years and we still don’t know a lot about its effects on kids.

mother child

But putting our kids in front of technology is sometimes hard to resist. Your kid is having a tantrum on the grocery line? Bring up a movie on the iPad. Children whining at the restaurant? Hand them your iPhone and see their little smiling faces and glazed-over eyes light up from the warm glow of the screen.

However, these solutions are often tinged with parental guilt and a nagging feeling that maybe we shouldn’t be doing this quite so much. To figure out how much is too much, I apply what I call the delight principle – and it’s perhaps not what it sounds like. It’s not experiencing the (yes) exquisite delight of  that whining/crying/fussing/annoying behavior stopping as quickly as if you pressed the mute button. Rather, it’s the idea that if we’re putting devices in our children’s hands so much that we’re losing opportunities to delight in them and enjoy their wonderful little selves, then we might want to reevaluate.

In a nutshell, devices can be used in a “disconnecting” way that, over time, can reduce a child’s experience of that  loving twinkle in your eye, that unconditional positive regard that is the cornerstone of a happy childhood.

This notion – show your child that you delight in them – is obvious in many ways.  But I think that in the cacophony of all the “expert” parenting advice out there – from free range parenting to attachment parenting – this simple instinct that every parent has is easy to lose track of. When children are NOT being delightful (often!), devices are not necessarily a parent’s best friend. Here are a few ways that delight can be blocked when devices are used to disconnect during frustrating situations:

1. Remember to twinkle: Children need to see themselves literally reflected in our eyes in the form of that loving twinkle. It’s not that we need to praise them (and indeed there is good research coming out now about the downside of praise) but rather we need to take joy in their accomplishments, mirror their journey of self-discovery, and be our children’s promoters (as distinct from praisers). Putting devices in front of our kids “too much” has the effect of directly, physically blocking that twinkle. We need to trust our guts as parents on how much twinkle we want to block and make a mindful choice.

2. Share your child’s world: Take time to see the world from your child’s perspective. Every parent knows that it’s a magical place. Explore the world together, discuss ideas, point out things that are interesting or puzzling or wonderful. Listen to what they have to say about it, and if they don’t have much to say, just be with their experience of it and share your experience. Using a device to share in your child’s world seems like one of the best possible uses of a device. So, when we bring out a device, we can choose to use it to connect with our children or to tune them out.

3. Help your child find their own inner delightful child: Just in case you were starting to think I am a proponent of “just twinkle and let the hard stuff go” – not the case. By #3 here, I mean I think we shouldn’t be afraid to talk to our child about being civilized and polite – yes, delightful – human beings. I think that children who are explicitly taught and socialized to be polite, compassionate, and empathic will on average be delightful children and will grow up to be delightful adults. And the converse is also true. I think too much device time reduces opportunities to guide our children towards being delightful. Moreover,  we have to believe that a child is delightful for this to even work. With too much device time I think it’s harder to know how delightful our children truly can be.

There are definitely times when I choose to use a device to press that mute button and just take a break. But when this starts to become a family habit (are they on the device every time you go out to dinner, precluding opportunities to actually talk with one another? Are they spending so much time watching tv that you don’t know how their day at school was? ), it might make sense to do a delight check and make sure the technology choices we’re making for our children sit right with us.

 

 

 

Reducing Anxiety with a Smartphone App

Some great coverage on our hot-off-the-presses study on reducing anxiety with a smartphone app. You can find the scientific paper here. And you can learn a little bit more here.

This is a picture of a smartphone.

Mental Health on the Go

My forthcoming research paper reporting on a mobile app that gamifies an emerging treatment for anxiety and stress  – a paper that hopefully will be officially out in the next month or so – is starting to be discussed in the media, including the Huffington Post. Thank you Wray Herbert for such great coverage of the study.

 

 

Focus and Distraction: Two Sides of the Same Coin?

Two recent posts by Stowe Boyd on GigaOm Research cover some really interesting research and ideas on how distraction can help us focus our decision making abilities, and how allowing our minds to wander via internet surfing (as long as it remains under 20% of your total time!) may boost productivity in the office. Thanks, Mr. Boyd.

It’s interesting to think about these ideas in the context of the debate that I am sure everyone has weighed in on at some point: Is the mobile device preoccupation many of us seem to have “good” or “bad” for us? Does it reflect some sort of obsessive multitasking, or the desire to escape our current moment? I think research findings like the ones discussed by Stowe Boyd point to the possibility that by asking this, we’re probably asking the wrong questions. Being on a device frequently is neither innately good nor bad – its effects depend upon when, why, and how much we use the device, and on whether it becomes a barrier to other ways of communicating, thinking, and learning.  This research also suggests that one of the factors that could influence our desire to be on mobile devices is that we all feel the (healthy?) need for distraction. The trick here is to make sure the power of distraction is harnessed for our well-being, and doesn’t just serve the desire to tune out or escape the present moment.

Connectedness and the Call of Anxiety

A study suggests that more frequent mobile phone use might make you more anxious. This could reflect the burden of constant social connectedness, or even nomophobia –  the “no-mobile-phone phobia” of losing connection. But we shouldn’t forget that this is a clear chicken and the egg question….. Are devices making us anxious, or do people who are already anxious just use devices more frequently?

 

 

Laying down a social marker

Psyche's Circuitry:

Another thought-provoking piece by Gareth Price about how the pressure to share via social media may be influencing the quality and quantity of our ideas.

Originally posted on DisCoverage:

frustrated_writer_by_photonerd88-d3gobx6BrainJuicer’s Tom Ewing wrote a blog post today about how the way we listen to music could change.

He envisioned people will soon have “attention regimes, in the way they follow dietary regimes and exercise regimes, and will have them in public: a proclamation of one’s listening regime will become a kind of social marker”; adding:

Demonstrating you can pay attention in a world of instant clicks will be a mark of presumed character (and bragging rights) in the same way demonstrating you keep fit in a world of chairs and screens is among white-collar workers now.”

Ephemerality is built into the internet.

If you don’t update your website Google will punish you by pushing you down its search rankings.

Fail to tweet for any extended period and people will unfollow you.

Don’t update your status and friends will accuse you of being a ‘Facebook…

View original 229 more words

The Game Doesn’t Care: Why the Gamification of Mental Health Isn’t Working (Yet)

Games that are not games. There is a serious barrier to the effective gamification of mental health. This barrier is that the games we psychologists and health professionals are coming up with are not fun. In fact, they are totally uncool, border on the condescending, and wouldn’t motivate anyone to play for more than 30 seconds. This is the case even though the bar is set quite low because these “games” address things that people really want, like boosting our intelligence and memory, reducing depression and stress, quitting smoking, … fill in the blank. boring gameI’ve been fascinated with this disconnect between Psychology’s view and real-world acceptability. This disconnect is plaguing other fields as well, such as in the development of “serious games” for education. In this larger context, I’ve been working on the development of an app that takes a scientifically proven approach to reducing stress and anxiety, and embeds the “active ingredient” of this intervention into a game that is fun – fun enough, we hope, for someone to want to play for much more than 30 seconds.

Fun versus health goals. In the midst of  this ongoing development process, I had the pleasure of speaking with Nick Fortugno, co-founder of the game design company Playmatics. In addition to creating really fun games, like Diner Dash, he has created games to promote positive social change and is one of the visionary and forward-thinking advocates for the idea that serious games can and should be fun. So, he has a deep understanding of the barriers facing the gamification of mental health. As we were talking about these barriers, Nick said something that really got me thinking. He said, when we design games for education or health, we have to remember that “the game doesn’t care” about whether we’re making progress towards our goal. This elegant idea highlights the fact that a game isn’t fun because it meets some criterion we have for success – like boosting our ability to remember, reducing symptoms of anxiety, or losing 5 pounds. A game is fun because it creates an aesthetic experience and facilitates game play that we want to come back to again and again. Therefore, I would argue that a “serious” goal embedded in a truly fun game is reached almost as a by-product of the fun.

The need for backward engineering. I think I am accurate in saying that very few people, myself included, who are trying to create serious games for wellness think like this – i.e., like a game designer – about the process of gamification. From what I can tell, game designers think very deeply about the experience they want the game to promote, and then they work through the pragmatics of the game play that will facilitate this experience. This backward engineering from the point of view of the aesthetic/experiential goal to the pragmatics of the game is the opposite of what psychologists do when they think about gamification. Instead, we have parallel streams of development in which (a) we know that our “game” (read scientific protocol) is truly boring, and (b) we have to somehow decrease the snore factor. We think: “Hm, here is my very rigid experimental protocol/computerized intervention. I must overlay this protocol with some cute little animated guys, perhaps with a fun back-story (wizards? aliens?) and then make sure users get points when they conform to the requirements of the protocol.” Sounds thrilling, huh? So fun? Exactly the recipe for the next Dots? Right…. So, we have a lot to learn from game designers, and I believe that crucial to the future of the endeavor of gamifying mental health is partnering with people who know how to create fun and understand the process of game design.

Pocket rituals. What would it be like if we created mental wellness tools, or even interventions for serious mental health problems, that were truly fun and that could become part of our array of habits and strategies for feeling better, reducing symptoms, performing more efficiently, or dealing with stress?  These games, if “snackable” would become our pocket rituals, our chill pills. We could take out our device for 5, 10, or 15 minutes and be empowered to bring about a targeted, appreciable positive impact. The barriers to use should be minimal, the experience intrinsically rewarding – that is, it feels good to play – as well as reinforcing because it helps us meet our health goals. I think many psychologists feel that this approach is not easily conducive to a rigorous scientific approach. But if we fail to find a way to do this – good science and giving people tools they want to use – then the whole endeavor is dead in the water.

The Happiest iPhone on the Block: Why Managing Your Digital Life is Like Good Parenting

When I started blogging a little over a year ago, I was a true social media skeptic. I drew more inspiration from thinkers like Sherry Turkle than Anil Dash. But my experiences with social media have turned this on its head. I’m still a skeptic in the sense that, as a scientist, I believe we need to know a lot more about how social media affect our lives for better and for worse. But I don’t feel the kind of concern I used to feel. Perhaps I’ve been tempted by the siren song of technology, lulled by a false sense of security engendered by the all-consuming digital embrace… but I don’t think so. I actually feel more in control and less overwhelmed by social media and other digital forms of communication than ever before. I feel they are tools, which I can selectively choose among and harness. I believe that a sense of well-being and balance in social media use is possible if we use some simple practices. The best metaphor I can think of for these practices is that they are the types of things that an effective and sensitive parent does. Here are the top five “parenting strategies” I’ve used to manage my social media burden:

naughty child

  1. Establish rules and set limits. Children thrive when there are consistent limits and structure. In the same way, our technology use needs rules and limits. If I don’t set limits on when and how I use social media, I’m more likely to get sucked into the black hole of keeping up with every tweet/text/email/post/newsfeed. I’m more easily distracted by social media, less present with others, and more likely to waste time and be less efficient because of it. Like all good parents, I try to create structure that is firm but fair. Harsh discipline might work in the short term, but the child usually rebels. So, I try not to be unreasonable or unrealistic about the rules (e.g., “I can only check email once a day, and for no more than 10 minutes” doesn’t work). I’ve tried to find a set of guidelines that work with my life and make me happy.
  2. Monitor communication technology use. It’s 10 o’clock. Do you know how much social media you’ve used today? This is really about being mindful about how we’re using our technology. I prioritize my time – I only have so much time and attention in a day, and so I try to spend my mental and social capital wisely. I keep track and schedule times that I will use these tools, and know the times that they need to be put to bed.
  3. Reinforce good behavior. It’s not only the amount of time we use social media or communication technology. It’s about how we use it and what it brings to our lives. I try to select digital communities that brings something positive to my life and that cultivates a positive peer network.
  4. Selectively ignore. In parenting, the idea here is that if a child is showing a troublesome behavior, as long as it’s not destructive, it can be “extinguished” by just ignoring it. If there is no reaction, and no reward, there ceases to be a reason for the child to act that way. And then the child stops being a nuisance. In the similar vein, when I start to feel that my communication technology use is becoming burdensome and bossy, when I feel the pressure to respond to every message or push notification is too much, I start ignoring it. Most of us like the feeling of being connected, and hope that the dings and rings on our devices will bring something good into our lives or that stressful things can be averted and dealt with quickly. So, we start to check obsessively and end up spending dinner time with our family on a device, or walking into traffic with our eyes glued to our iPhone. When I begin to move in this direction, I reverse course and start to consciously and selectively ignore my devices in order to break the cycle.
  5. Adapt technology use to fit my life. One key to being a good parent, I believe, is structuring your life so that it can accommodate children in support of their well-being and happiness. Some (in my opinion) not-so-great parents do the opposite, they expect not to change their lives at all and that children should just fit in. In contrast to my list of strategies thus far, when it comes to mobile technology and social media I try to follow the inspiration of the questionable parent: I fit technology into my life so that I remain able to do what I want and need to do without being sidetracked. If my life is becoming  more stressful and less organized because of social media burden, then I’m probably doing the opposite.

So remember, when that naughty stream of Facebook status updates are just too much to handle, you’re a week behind on your twitter feed, the pesky email inbox just won’t empty out, and those 10 texts – that are going to go unanswered for another few days – won’t stop bugging you, ask yourself: what would mom do?

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