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?

Appily Ever After?

I was very interested to read this funny take  on psychology smartphone apps in the New York Times (by Judith Newman) – or more accurately, how NOT to build a psychology app. I just blogged about this general topic in my last post, and what struck me most about this article was the notion of time.

Image

Art by Emily Flake (published in the New York Times 4/5/2013)

This article seems to suggest that mental health apps should quickly and effortlessly facilitate our relationships, efficiency, and well-being. As Newman writes in the article:  “All of these apps require thought. Lots and lots of thought. Thinking is what I do all day long. I needed something that would turn my mind off, not on.”

Great point. Maybe we don’t want the app to be our shrink – because when we go to a therapist, we tend to have a set of expectations that involve spending a good deal of time and energy (unless we’re just looking for a medication fix). Apps, by their nature, are fast, easy, and mobile. So, most of us expect that a psychology app will be a shortcut to mental health. We shouldn’t have to spend time learning how to use the app or being on it too much – at least not so much that it’s taking away from “having a life.”

This view tells me that there is a potentially deep disconnect here: between what many of us in the mental health field think of as the promise of mobile health technologies and what everyone else thinks. Many psychologists see a future in which apps and computerized therapeutic tools break down barriers to treatment, which can be too expensive and intensive for many. For example, for the most common class of psychiatric disorder, the anxiety disorders, only about 20% of anxious people receive treatment! So, the psychologists are thinking, jeez, mobile technologies offer so many amazing possibilities for integrating mental health treatment into the daily life of people who are suffering.  Let’s create an app for that!

But we need to think through our approach carefully. If we just put the same old (frankly boring) computerized interventions on smartphones, will that actually help us reach more people? How many will choose to use these tools? Maybe some, but perhaps not many. Perhaps what most of us want from an app is the digital and interactive version of the self-help book – you can take it or leave it,  pick it up and put it down after a few minutes and still get something from it, and which doesn’t feel like just another source of techno-burden.

So, what is the take-home message for the mental health professionals? Make it fun, make it fast, and make it effective or get back to work on making traditional treatments better.

Gamifying Mental Health or: Mental Health – We Got Game

I just attended the second annual Entertainment Software and Cognitive Neurotherapeutics Society (ESCoNS) conference. Say that five times fast.  This conference brought together people in the gaming world with cognitive neuroscientists. I went because I’m developing (and testing) an app that I believe can help people reduce stress, worry, and anxiety in their lives. In addition to more deeply exploring how to make mental health truly fun, I felt that I was seeing the future of mental health unfolding before my eyes.

Gamifying mental health

Here are four ideas I think will change how the field of mental health will look in a decade (or less):

1. Mental health care WILL BE gamified. The mobile revolution and app zeitgeist have changed how we get things done. We want an app for everything because we want our life mobile and streamlined, and the minute we think we want to do something, we want a device to help us do it. We also are trusting ourselves (and our networks) more and professionals less. This is the self-help movement taken to a new level. If we can seek mental health support on our devices rather than through a professional, more of us will do so. This plays into our growing tendency to feel more comfortable with devices than with others – this may be good or bad, or somewhere in between, but this is how it is.  I believe that it is not whether mental health care will be gamified, it is only a question of how and when.

2. Fun will motivate mental health treatment seeking. Scientists interested in human beings understand how to break something down into its component parts (whether an idea, a behavior, or a biological response) to study it, but scientists are not trained to construct something that is fun and that motivates people to come back again and again. That is art and intuition, combined with a lot of experience and good old-fashioned luck. If we want to reach the greatest number of people, and help them integrate mental health interventions into their lives, we need to make mental health fun.

3. Training your brain….with video games? The idea that you could train your brain with video games is still perceived by many to be in the realm of science fiction. But if you think about the fact that every experience we have, particularly repeated experiences, change our brains – why wouldn’t a video game? This reflects the important concept of neural plasticity – that the structure and function of the brain is malleable and changeable not just in childhood, but throughout the lifespan. In addition to games that can train different abilities (e.g., attention in kids with ADHD) technologies like virtual reality are being used as safe and effective ways to treat everything from addiction to post-traumatic stress disorder.

 4. The Emotional Brain is a “buzzing” target for intervention. In the 20th century, psychology was dominated by cognitive theories of how the brain works and what causes mental illness. Emotion was a little blip on the screen, an irrational irritant to the otherwise rational, predictable, and orderly domain of the thinking mind. Now, that irritant is an increasingly important focus of research. For example, not much more than a decade ago, economic decision making was understood as a “rational” process. Now it’s assumed that emotions influence our decisions, for better and for worse, and the task is to figure out how. The effect of emotion is not “irrational.” Rather, it reflects the fundamental integration between our ability to feel and to think. Without one, the other is deeply impoverished. As an emotion researcher, my colleagues and I are happy everyone has caught up – it’s about time! Emotions are the engines of our lives – and of psychopathology. No real living happens in an emotional vacuum.

It was clear to me from the conference that there is an emerging field in which the gaps between clinical psychology, cognitive neuroscience and entertainment are being bridged. This field is fundamentally interested in the emotional and social brain and “healthy emotional brain architecture” will be the goal of many computerized, gamified interventions. Increasingly, people predict a (near) future in which games will routinely be prescribed in the doctor’s office, and may eventually replace the office visit. If we can change our emotional brains, we can change ourselves. At least, that’s what many are counting on.

 

Rebel Without a Status Update

I am fascinated by the psychology of Facebook status updates. There are many reasons to make a status update. One reason, of course, is obvious – let others know what you’re up to or share something that’s cool. For example, if I did frequent status updates, I might decide to post “Buying a fantastic ½ pound of Australian feta at Bedford Cheese Shop on Irving Place – should I up it to a pound?!” (and seriously, it is incredible). This may be an interesting snapshot of a day in my life, but these types of status updates are exactly the ones that tend to annoy me for some reason. Even the most benign version of this feels like TMI.

Why? Status updates are for many an instinctive way to reach out.  A recent study even showed that increasing the number of status updates you do every week makes you feel more connected to others and less lonely. Seems like a good thing! Moreover, it’s consistent with what seems to be our new cultural comfort zone – being virtually seen and heard by a loosely connected group of people we know (or sort of know) as our “social network.” This virtual network is the social status quo for many of us, and certainly for many children growing up today.

I believe one consequence of this is that no one wants to be James Dean anymore. Putting it another way, maintaining privacy and being a strong silent type, like Dean, are no longer alluring ideas to us.  And when I thought of this, I realized why I don’t feel fully comfortable with the status update culture – I am a proponent of the James Dean School of Sharing Personal Information in Public: motto, the less the better. I like understatement, privacy, the choice to share with a few and retain privacy with most.

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It’s no coincidence that as a culture, we don’t fetishize James Dean any more. Many of today’s icons (some of them “anti-icons” because we love to feel superior) are people who humiliate themselves, who will tweet that they’re on the toilet and what they’re doing there, who end up in compromised positions, and happen to have pictures and videos of those positions, which then promptly go viral (funny how that happens). James Dean would have disapproved.

James Dean himself would have been very bad at social media…..or perhaps very, very good. Very bad, because he would have had little to say, and would have hated the constant spotlight and social media culture of ubiquitous commentary and chit chat. On the other hand, he might have been very good at it because he would have been the Zen master of the status update, expounding with haiku-like pithiness. An imaginary James Dean status update:

James Dean…….

Old factory town

Full moon, snow shines on asphalt

#Porsche alive with speed

But seriously, while he probably wouldn’t have written haiku, perhaps he somehow would have figured out how to use sharing to create a sense of privacy, because a sense of mystery would have remained intact.

Yes, the status update is a beautiful thing. We have an efficient and fun tool which allows us to reach out to others, curate our self-image, and think out loud to a community. But I wonder if we’re starting to lose the simple pleasures of privacy, of knowing less and wondering more.

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