Integrating Mobile Technologies

intoMental Health Treatment

Frederick Muench, Ph.D.fm2418@columbia.edufred@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 AppsBehavior Tracker Pro Datahabit Daytum

TallyZoo

“Mood-Tracking” AppsMood 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 MatterHomework and self monitoring are enhanced when there is accountability.

Mohr, D. C., Cuijpers, P., & Lehman, K. (2011)

TallyZoo Example:

Sensing….

• 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

Questions

fm2148@columbia.edu

Thank You