09.11.10

Get Therapy Through Your iPhone

Attention, smartphone addicts: Now you can get treatment for that addiction through the very device that enslaves you. Josh Dzieza on psychology’s new technological frontier.

Plenty of people joke about their addictions to their “CrackBerries,” and there’s likely more than a bit of truth to that. (Indeed, the new DSM, the mental health bible for psychologists, may include “ Internet addiction” among its many pathologies.) But while smartphones can certainly enable compulsive behavior, surprisingly psychologists are increasingly seeing them as a tool with potential mental health benefits.

Capitalizing on the ubiquity of the increasingly powerful mobile devices nearly everyone carries around nearly all the time, clinicians, researchers, and software developers are designing cellphone apps to give patients psychological help on the fly. Marientina Gotsis, media lab manager at USC, started thinking about designing apps with therapeutic potential when she realized that her phone had joined her wallet and keys on the small list of things she never left home without. “It’s what keeps people connected, functional, feeling safe and entertained. So why not use what people hold on to close to deliver behavioral interventions?”

It’s the kind of innovation that Kathleen Carroll, a psychology professor at Yale, says may be a “small revolution” in mental health care. These apps are part of the “brain fitness” industry, a category that includes computerized memory exercises and cognitive-impairment assessment programs, and that SharpBrains, a company that analyzes the industry, estimates to have grown 35 percent in 2009, to $295 million.

Many of these programs are being developed to treat addiction. Patrick Dulin, who is working on an app at the University of Alaska Anchorage, got the idea for his program while helping develop an app that tells hunters when they’re on hunting grounds. The project reminded him of a problem he faced while working in the substance abuse clinic at the San Francisco VA hospital. Despite warning patients to stay away from bars where they used to drink and neighborhoods where they used to buy drugs, “eventually they’d end up there, and their stories would be something like, ‘Well, I was just walking along and I thought maybe I could just kind of go see if it still had the pull.’”

So, with funding from the National Institutes of Health, he designed an app. Whenever a patient gets near a risky area, a message pops up on his or her phone with coping strategies, or requests for support are fired off to family, friends, or sponsors. “Our frontal lobes are the part of our brain that helps us stay focused and stay on track,” Dulin says. “One of the ways I think about this system is that it’s kind of like your frontal lobe outside of yourself.”

At the University of Massachusetts, Edward W. Boyer, M.D., Ph.D., takes it a step further. He hooks up a wireless pulse and skin-conductance anklet to his patient’s mobiles, and his app intervenes whenever it detects that its user is anxious or craving. The algorithm is still being tweaked, but Boyer says that 80 percent of the time it can correctly distinguish between seven emotions, including anger, frustration, platonic love, and lust. “That’s as good as the recognition accuracy on the initial voice-recognition programs,” he says.

He hooks up a wireless pulse and skin-conductance anklet to his patient’s mobiles, and his app intervenes whenever it detects that its user is anxious or craving.

With funding from The Robert Wood Johnson Foundation, Dr. Charles Kinzer, a professor at Columbia Teachers College, is designing a game to simulate the experience of smoking. Because cigarettes can be either a stimulant or a relaxant, the game has two modes. In one, players breathe quickly into their phone’s mic in order to speed a spaceship through a vibrantly colored asteroid belt. In the other mode, they breathe slowly and deeply to expand a cloud of dust.

The idea of getting counseling from a computer or smartphone may seem strange, but it’s been in the works for years. In 2006, the British National Institute for Health and Clinical Excellence recommended two programs, Fear Fighter and Beating the Blues, as first-line treatments for mild-to-moderate anxiety and depression.

Both these programs, like most of the cellphone apps being designed, administer cognitive-behavioral therapy, or CBT, a form of therapy developed by Aaron Beck in the 1960s as an alternative to traditional psychoanalysis. Cognitive behavioral therapy is extremely standardized, with lessons and exercises that patients complete in a set number of sessions. This makes CBT relatively easy to automate. Kathleen Carroll suggests CBT might even work better as a computer program, because computers let people do exercises at their own pace, watch videos of people using CBT techniques, do role-playing activities that therapists often don’t have time for, and “are potentially available 24/7, and to people in more remote areas where CBT-trained clinicians are often not available.”

As for where all this is headed, researchers are optimistic but uncertain. While stressing that more testing has to be done, they say that computerized and mobile therapy will allow them to help patients outside the clinical setting and to treat more people at less cost. “My sense is that it could be one of the next big waves in health care, and not just addiction,” says Dulin. “We’ve really just come to the point in the last four or five years where we’re able to do this sort of thing, we have the technology to make these ideas a reality.”

The buzz surrounding mobile health in general indicates that Dulin is right: There were the first ever mobile-health summits in Davos, Switzerland, this June, and in Singapore, this July. The second annual “mHealth Summit,” sponsored by the NIH, is scheduled to take place in Washington, D.C. this November. It’s expected to draw 2,000 people, quadruple the number that attended in 2009. Bill Gates will be the keynote speaker. This month, Carroll published an overview of the field online in Current Psychiatry Reports. The title of the article: “Computer-assisted Therapy: Be Brave—It’s a New World.”

Josh Dzieza is an editorial assistant at The Daily Beast.