integrating mobile technologies into mental health treatment frederick muench, ph.d....
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Integrating Mobile Technologies
intoMental Health Treatment
Frederick Muench, [email protected]@healthtxts.com
Disclosures
• Owner: Mobile Health Interventions: Text messaging company for health services and research. In the process of “selling” company.
• Consultant: Several mobile health companies, none of which are mentioned in this presentation.
Mobile Adoption
• 83-95% mobile phone use, including low income & disenfranchised groups
• 98% are SMS ready
• 50% smart phone adoption based on SES, expected to skyrocket• Mobile internet users will reach 113.9 million in 2012, up 17.1% from 97.3
million in 2011• By 2014, mobile will become the most common way of accessing the
Internet• Use driven by age – not SES
• No Digital Divide• 90% of individuals in intensive government subsidized outpatient
substance abuse care had an active mobile phone
• *19-26% of mobile users use their phone for health (mostly fitness). *MR 2012, Pew, 2012
Why Mobile?• What, Why, How, When & Where
24/7 access to increase salience of change goals in-vivo:• Assess & monitor using multiple mediums (active & passive)• Tailor & intervene/adapt care (just-in-time)• Triage & crisis intervention• Network with supports• An extension IBIs
• Data Download• Improve data quality, display and monitoring, EMR integration,
dashboards, research, etc.
• High level of client acceptability in mobile - clients want to stay connected
• Mobile combines “safe distance,” but continued monitoring
Top 10 Health Searches: 2011
Web Searches:
CancerDiabetesSymptomPainWeightInfectionVirusDietThyroidSleep
Mobile Searches:
ChlamydiaBipolar disorderDepressionSmoking/quit smokingHerpesGoutScabiesMultiple SclerosisPregnancyVitamin A
Empirical DataIt’s coming….. I promise
Very little on mobile applications:• Pilot studies on development with small N’s
By far, the most on text-messaging:• High acceptability, appointment adherence
• HIV medication adherence
• Depression
• Smoking & Alcohol Use
• Weight loss
• Diabetes & Asthma monitoring
Mobile assessment – the one place we are ahead of the game!
“Agile” Research Designs (Hekler, 2012)
Capabilities Built Into Smart Phones
Wireless Data Access Real-time analysis and feedback
Apps & Mobile Web Connectivity to data, providers and social support
Speedy Processing Tailored personalized Medicine – just-in-time
Device add-ons Diagnostics
Capabilities…
Voice & Text IVR, Reminders, Contact, interactive, decision support, emotional tone, recognition
Camera/Video Telepsych, modeling, environmental monitoring
Accelerometers/Activity Behavioral activation, Relapse, Side effects, Sleep
GPS, GIS Triggers, Activity scheduling, etc.
Galvanic Skin Response, Temperature, Heart Rate Variability
Predict outcome, Relapse, Side effects
Stand Alone Apps
• There are also numerous applications that attempt to provide overlapping services as therapists and specifically highlight CBT theory such as iCBT, ICouchCBT, eCBT, CBT Referee, eCBTMood, CBT Clam, iCounselor
• Other apps including things like PTSD Coach with four modules focused on 1) education, 2) self-assessment, 3) symptom management, and 4) social support.
• Stand-alone apps work well with consumers who are highly motivated but cannot afford treatment.
• Dr. Boudreau will perform a full review next
General Apps
Behavior Tracker Pro Datahabit Daytum
TallyZoo
“Mood-Tracking” Apps
Mood Scope T2 Mood Tracker Mood Panda Moody Me Mood Swing
Goal-Setting Apps
Use similar techniques, but focus on goal-directed behaviors
Habit Factor Livifi
Self Tracking/Goal Setting
2.04 Bases for Scientific and Professional Judgments:• Psychologists' work is based upon established scientific
and professional knowledge of the discipline(See also Standards, 2.01e, Boundaries of Competence, and 10.01b, Informed Consent to Therapy)
Self-monitoring is one of the most highly effective behavior change techniques across behavior change domains (Michie et al. 2009; 2012; Webb et al. 2011).
Self-Monitoring is
Essential for Change
The biggest problem is….
Therapists Matter
Homework and self monitoring are enhanced when there is accountability.
Mohr, D. C., Cuijpers, P., & Lehman, K. (2011)
TallyZoo Example:
• Activity Monitoring• Fitbit, Nike Plus, Body Media, etc.
• Sleep• Zeo Personal Sleep Coach, Sleep Stream 2 Smart Alarm
Clock, Sleep Cycle
• GPS, Geolocation (Behavioral Activation)• MapMyTracks.com, endomondo, InstaMapper, CHESS
• Passive sensing – using features embedded in the phone• BeWell
Passive Sensing
Dashboards Can Keep You Connected
Client Centered
AccelerometerTemperature sensorGalvanic skin response sensorHeat flux sensor
As social as you want it to be….
• Hardware limitations/malfunctions
• Lost phones/devices
• multiple numbers in short-periods of time
• Limited proactive use by individual
• Individual privacy concerns
• HIPAA
• FDA
Obstacles • Cost
• Limited empirical data
• Confidentiality & Privacy
• Scope of Practice
• Reimbursement
• Consent
• Real-Time Emergencies
