Digital Mental Health in the Era of Techlash: Towards Humane Health Technology

Note to readers: This is a long-ish read (closer to 15 rather than 5 minutes)

As someone who studies mental health, I rarely stop to ask myself about its definition. Yet, definition is increasingly at the front of my mind when I think about the field of digital mental health.

I know all the modern textbook definitions, but find myself drawn to a definition that was put forward over 60 years ago by Erich Fromm in his book The Sane Society. One of the founders of what would come to be known as Humanistic Psychology, Fromm wrote “Mental health is characterized by the ability to love and to create, ….by a sense of identity based on one’s experience of self as the subject and agent of one’s powers, [and] by the grasp of reality inside and outside of ourselves, that is, by the development of objectivity and reason.”

I love this definition because of its focus on what seems to me to really make us human: loving, creating, and having a desire for knowledge. The field of digital mental health is moving forward at a breakneck speed without considering the basic question of how it might promote – or disrupt – these building blocks of a sane and humane society and of our individual mental health within it. Moreover, it is developing in a world of obsessive social media use, mobile phone addiction, fake news, digital data insecurity, internet trolls, and the Uber-fication of human service industries, all of which serve a single, primary objective of absolute efficiency – getting what we want as quickly and easily as possible at all times.

Here I highlight key challenges we face in creating humane and effective health technology in a toxic digital ecosystem, lay out a four-point road map, and, as a case study, describe the development of a micro-intervention app for stress- and anxiety-reduction I developed called Personal Zen.

The Promise of Digital Mental Health

The potential payoffs of digital mental health are of crucial importance now. We are facing an ever-growing mental health epidemic in the US and around the world. Over half of us will be diagnosed with a mental health disorder in our lifetime. And our kids are struggling. Approximately one in every 4–5 youth in the U.S. meets criteria for a mental disorder with severe impairment, and the vast majority of mental health disorders in adults first emerge in childhood and adolescence.

The particular promise of computerized and mobile interventions are that they can, if done properly, radically increase the availability and accessibility of empirically-validated treatments, while reducing cost and stigma.

The Toxic Digital Ecosystem and Techlash

We’re used to believing, with true tech-enthusiasm, that if only we can “disrupt” current healthcare delivery systems, we can solve all our problems. But we now realize with growing certainty that what the digital ecosystem truly excels at is making money for technology companies and pushing us towards ever-greater efficiency. It does this so well because it is precisely and purposefully designed to grab our attention, addict us, and keep us glued to our screens: This is the basis of the attention and surveillance economies. The result of this design focus is that digital technology exhausts us, distracts us, and detracts from our ability to do other things.

Awareness of this has caused the pendulum to swing the other way, and we’ve entered an era of “tech-lash” with growing outcry about mobile phone addiction, negative effects of social media on youth mental health, data security, the spread of fake news, unethical business practices, and the list goes on. We are angry at Silicon Valley because these powerful companies created ubiquitous products and put profit so far above our well-being, that it’s unclear what to do about it.

Such is the degree of techlash now that even scientists are seeing causation in correlation before solid facts are established. In 2017, researchers, usually a circumspect bunch, went so far as to suggest in the popular media that smartphones have psychologically destroyed a generation of youth, citing among other findings that during the period following the birth of the iPhone about 10 years ago, we have seen a doubling of suicide rates and increases in depression and anxiety across vast segments of society.

In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting “overwhelming anxiety” in the previous year. Surveys that look at experiences related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they “felt overwhelmed by all I had to do” during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent. These are alarming statistics, but is this enough evidence that smartphones are causing these problems?

I believe not. I have come to doubt conventional wisdom that smartphones or social media are a unique cause of anxiety, depression, or suicide; instead, I see them as a factor among many. By primarily “blaming the machines” we obscure the impact of other factors of equal or perhaps greater importance, and lose opportunities to deeply examine a range of factors and how they might work together with digital technology to contribute to the suffering of youth and adults.

As the evidence comes in, how do we work in an arguably toxic digital ecosystem to ensure that – for adults and children – health technology heals rather than harms?

A Four-Point Road Map for Humane Digital Mental Health Technology

For health technology to be truly humane, it must meet these four criteria:

  1. Prioritize development of micro-interventions. An irony of digital mental health is that the well-honed attention economy techniques that keep people glued to screens will work against mental health promotion. Therefore, focus should be on creating micro-interventions that require as little screen time as possible. Micro-interventions are brief and frequent, easily fitting into a person’s routine at home or on-the-go. They are part of the broader spectrum of care, with low-intensity preventative or “gateway” treatments at one end and intensive stand-alone treatments on the other end. Development efforts in health technology should be focused now on the low-intensity end of the spectrum. Later, once a strong evidence base is built, resources should then be devoted across the spectrum to develop more intensive, resource-heavy and stand-alone treatments. Spectrum of careThis strategy is largely reversed in digital healthcare right now. Many companies are trying to digitize gold-standard treatments like cognitive behavioral therapy (CBT), which remains time-consuming and expensive. Moreover, it remains unclear whether CBT is effective in digital or telemedicine format. Making poorly-validated treatments widely available does not solve the mental healthcare crisis.

 

  1. Maximize high accessibility. Along with the development of brief, micro-interventions, digital mental health must be qualitatively more accessible than current treatment delivery systems – affordable, easy to access, used on-the-go, and engaging. Current psychological treatments are often time-consuming and expensive. Of the over 160 million Americans who will have mental health problems in their lifetime, 50% of us don’t seek any treatment with 44% of these untreated patients citing price as a barrier. Basic access is also highly limited – over 83 million Americans live in federally-designated Mental Health Professional Shortage Areas.

 

  1. Reduce stigma. The stigma of mental illness represents a significant barrier to mental healthcare access. Of the tens of millions of untreated Americans struggling with mental health, 10% cite the stigma of mental illness – and fearing others will find out – as a primary barrier. A benefit of digital and mobile mental health interventions is that when we access mental wellness tools on our devices, they become part of our enjoyable and daily digital lives, increasing the possibility of normalization. Developers can also aim to create interventions that are fun and engaging, rather than having the clinical and medical feel that might turn people away from seeking help in the first place.

 

  1. Make adaptive and personalized. The promise of machine learning, artificial intelligence, and big data for solving health problems are immense. The most sophisticated techniques for data generation and gathering have been used in the worlds of advertising and politics, but these emerging techniques have already made waves in terms of medical diagnosis and risk assessment. In mental health, the ability to dynamically evaluate a treatment target and personalize interventions accordingly are the future of mental healthcare. At this stage, few research-based mental health tools have built-in adaptive methods. This is among the most important areas in which academia and industry must come together, one that holds perhaps the greatest promise for true personalization of treatment.

Summary: Development of humane and effective digital mental health technology must optimize the accessibility and mobility of digital technology, shift focus towards brief, flexible, and personalized interventions, and reduce screen time in order to step off the attention economy treadmill.  This approach minimizes the harmful aspects of the digital ecosystem while capitalizing on its nimble, accessible, and stigma-reducing aspects.

Finding Personal Zen

I had the idea of humane health technology as a guiding principle when I created the app Personal Zen. Personal Zen is a stress- and anxiety-reduction exercise. The app embeds scientifically-based attention training techniques into an engaging and appealing format. Its scientific “active ingredient” is something called attention bias modification.

Attention biases are rigid and selective ways of paying attention to information in the world. Decades of research tell us that people who tend to be anxious or stressed detect negative information more quickly, and pay attention to it longer and intensely than people who are relatively less anxious and stressed.

This preference to pay attention to the negative is called the threat bias.  And here’s the kicker: The threat bias piggybacks on one of the triumphs of evolution – the ability to quickly and automatically notice danger, which in turn triggers us to fight or take flight to deal with the danger. But the threat bias highjacks and skews this evolutionary advantage. It acts as an unconscious information filter, an imbalance in what we pay attention to that makes us actually prefer and prioritize threat and negativity at the expense of the positive. When the threat bias becomes a rigid habit of looking at the world, it puts our fight/flight response on a hair trigger, and sky-rockets our feelings of stress and anxiety. We see monsters in the closet even when they’re not there.

Personal Zen is designed to retrain our attention to disengage from the negative in flexible ways so that we can better benefit from positive information all around us. This creates a stronger attention filter favoring the positive. As a micro-intervention, it was designed to be used briefly and on-the-go, so it can fit into anyone’s daily routine.

Findings suggest that this technique loosens the vicious cycle of stress and anxiety, immediately reducing distress as well as laying the groundwork for positive change. We’ve published three clinical trials of Personal Zen showing that even with short-term use, Personal Zen can reduce stress and anxiety. We’ve recently focused on the potential benefits of Personal Zen for a group of people in particular need of easy-to-access stress-reduction tools that can fit into their busy lives – pregnant women – and found that using Personal Zen for about 30 minutes a week for a month reduced the stress hormone cortisol. While much more work needs to be done, I believe that with this approach, we’re on the right track.

The Future is Now

The field of digital mental health is skyrocketing at a time when there are compelling arguments to reduce screen time. Humane digital mental healthcare must navigate this contradiction while taking the best that digital technology has to offer to actively promote the essence of mental health in us all: the ability to love and create, to have an empowered sense of self, and to embrace objectivity and reason. It’s up to us all, researchers, developers, and healthcare professionals, to get this right.

Blast from The Past: The Day My Three-Year-Old Discovered Multitasking

Today we’re revisiting a post from a few years ago “The Day My Three-Year-Old Discovered Multitasking”:

I recently overheard a conversation between my three-year-old son, Kavi, and my husband. Kavi was about to go to bed and had only a couple minutes left to play. Dada asked him to choose how he wanted to spend his remaining time. Kavi said, “I have a great idea, dada! I can play iPad AND play Legos at the same time!!!”

Hoo boy, I thought. My son is becoming a multitasker at age three. Already dissatisfied with the pleasure of any single activity, he is trying to divide his attention between two things (one of which is a mobile device) thinking it will be more fun and he won’t have to miss out. Is this an expression of the dreaded FOMO, fear of missing out, rearing its head so early?

And thus followed a mental checklist of my potential parenting failures. Two stand out:

  1. I multitask too much in front of him. I am definitely a multitasker, but one who makes strong efforts to put away my devices when I am with my family. I don’t always succeed, so have I become a bad role model?
  2. I don’t encourage him to enjoy the process of doing and learning. As I’ve blogged about before, one way of thinking about styles of learning is making the following distinction: we can focus on and enjoy the process of learning, or we can learn with the goal of obtaining rewards (praise, grades, etc,…). If Kavi is so interested in multitasking, perhaps this is because he doesn’t fully enjoy the process of doing a single activity.

Then I thought on a more hopeful note, maybe I’ve done something very right, teaching him 21st century skills and facilitating his mental acuity:

  1. Multitasking in moderation is useful! Certainly, at this moment in time, people could be at a disadvantage if they are not able to take advantage of multitasking opportunities to gather information, learn, or accomplish goals – in moderation. So, the fact that it occurred to him to multitask two things he likes to do could simply indicate that his cognitive development is moving along nicely.
  2.  Maybe he is learning to augment his creativity via technology. Perhaps his thought was – well, I’m hitting a wall with new things to build with Legos so maybe I can use the iPad to come up with more ideas. But who knows what he was thinking. So I asked him.

The conversation went something like this:

Me: Hey sweetie, do you remember when you told daddy that you wanted to play iPad and Legos and the same time?

Kavi: mumbles something.

Me: What’s that?

Kavi: Yes, I think so.

Me: Why did you want to do iPad and Legos at the same time?

Kavi:  Because it’s the same kind of fun.

Me: The same kind of fun?

Kavi:  Yes. First you do iPad, then you do Legos. iPad, Legos, iPad, Legos….

Me:  But you also play Legos alone, just Legos.

Kavi: But that would be boring!

Me: Really? I see you do that all the time.

Kavi: Yes…..

At this point, I decided to drop it. So, what does this little bit of anecdotal evidence mean? I have no idea. But I think the bottom line is that I know my son and I’m not too worried. He is already quite good at focusing for long periods of time (he can build with Legos for hours if you let him). Perhaps, though, there is something I can do better. I could focus more on promoting his JOMO  – the joy of missing out. It’s the feeling that what you’re doing right now, at this moment, is exactly the perfect thing to do.

 

The Isle is Full of Noises: Digital Exile in the Play “Privacy”

Last month, I saw Privacy, a play by James Graham about the consequences of living our lives mediated by the internet and mobile technology.  Called a “magic show” by the New York Times review, it used Shakespeare’s The Tempest as a window into the pathos of this brave new digital world of ours.

At its core, the play is about how technology places us in exile, in which we struggle with feeling alone and cut off even though we are always connected with others, struggle with understanding our emotions even though we constantly express ourselves. One of the most interesting things to me about the play was that it included one of our era’s great exiles, Edward Snowden, who makes an appearance via a previously recorded Skype video. He and the protagonist of the play, The Writer (played wonderfully by Daniel Radcliffe) together recite a monologue from The Tempest:

Be not afeard. The isle is full of noises,

Sounds, and sweet airs that give delight and hurt not.

Sometimes a thousand twangling instruments

the isle is full of noises
from oxfordplayhouse.com

 

Will hum about mine ears, and sometime voices

That, if I then had waked after long sleep,

Will make me sleep again. And then, in dreaming,

The clouds methought would open and show riches

Ready to drop upon me, that when I waked

I cried to dream again.

In The Tempest this monologue was spoken by Caliban, the drunken, semi-human, despised but magical offspring of a witch who is explaining the mysterious and enchanting music of the island upon which all the characters in the play are trapped. The main protagonists of The Tempest are the magician Prospero, rightful Duke of Milan, and his daughter, Miranda, who were sent into exile and stranded on an island by Prospero’s jealous brother Antonio. Prospero, being a magician, has conjured a storm (the tempest) and set in motion a shipwreck and a series of events designed to gain back the throne for his daughter, the rightful heir.

Is Mr. Snowden Caliban, both despised and magical? Edward Snowden is certainly vilified by some – in exile in Russia after leaking NSA documents revealing the scope of secret surveillance carried out by the US government on its own citizens and on other governments. Others, of course, consider him to be a martyr and a hero. Mr. Snowden has said, “People say I live in Russia, but that’s actually a little bit of a misunderstanding. I live on the Internet.” To hear him recite “The isle is full of noises, sounds, and sweet airs that give delight and hurt not. Sometimes a thousand twangling instruments will hum about mine ears ….“ made me think about what it must mean for him to “live” on the internet, never escaping its ceaseless music, the chatter and flood of words, images, facts, attacks, ideas, pings, clicks, alerts, notification, requests, and likes.

It also made me think about what Mr. Snowden gave up in order to shine a light on the underbelly of all this noise. “When I waked I cried to dream again.” This is the sting of being a citizen of the internet, unable to forfeit the joys and miracles of our shared, cyberspace dream, but knowing that we are being used by others for their own purposes, our privacy no longer sacred, but instead a pawn in the game, an asset to leverage and sell. Most of us accept this. Mr. Snowden does not.

Privacy leaves us with the feeling that our digital lives are a form of exile in an enchanted, cacophonous realm, a place where the technology we are dependent upon seems both magical and menacing.

 

 

 

Calming the Politics of Fear: Technology and the Anxious Brain

“Calming the Politics of Fear: Technology and the Anxious Brain” is my talk from Personal Democracy Forum 2016 (June 10, 2016), adapted here for a written format. This talk was part of a set of talks entitled “Tools We Need.” I argue that using technology in the service of health is a very sharp, double-edged sword, and that we must reclaim technology culture to serve and amplify humanity and well-being, rather than serve the digital economy. The video of the talk is available here.

Threat Bias

I became a psychologist and a researcher because I wanted to help people overcome problems like anxiety and depression. But I quickly discovered that no one likes you when you are a mental health professional. Psychologists pry into people’s minds and tell you it’s your mother’s fault. Psychiatrists prescribe you drugs with terrible side effects and that emotionally numb you. It’s no coincidence that Hannibal Lector is a psychiatrist.

And that’s when I got it. We psychologists and psychiatrists have profoundly failed people. We have failed to give people the treatments they need – and instead give people treatments that are too expensive, too time consuming, too hard to access, and perhaps most importantly, deeply stigmatizing. Largely because of us, people fear that their hearts and minds will never heal and that they will continue to feel broken inside.

I believe that digital technology can offer us some unique ways out of this mess, and provide tools for both professionals and each of us as individuals to heal problems like anxiety and depression.

But I also believe that using technology in the service of health is a very sharp, double-edged sword, with high potential costs as well as benefits.

In my research lab, we study things called cognitive biases – invisible habits of thinking and paying attention that intensify and even cause anxiety, depression, and addiction. I’ve translated this research into digital techniques that are designed to short circuit cognitive biases.

Let me explain cognitive biases by conducting a little experiment. Please fix your eyes on the screen. [[The following picture flashed up on the screen for 2 seconds]]

angry face

How many of you saw the angry face? How many didn’t? The results of our experiment?: Decades of research tell us that people who tend to be anxious or stressed detect that angry face more quickly, and pay attention to it longer and intensely than people who are relatively less anxious and stressed.

This preference to pay attention to and prioritize the negative is called the threat bias.  And here’s the kicker. The threat bias piggybacks on one of the triumphs of evolution – the ability to quickly and automatically notice danger, which in turn triggers us to fight or take flight to deal with the danger.

But the threat bias highjacks and skews this evolutionary advantage. It acts as an unconscious information filter, an imbalance in what we pay attention to that makes us actually prefer and prioritize threat and negativity at the expense of the positive. When the threat bias becomes a rigid habit of looking at the world, it puts our fight/flight response on a hair trigger, and sky-rockets our feelings of stress and anxiety – We see monsters in the closet even when they’re not there.

For example, imagine you’re giving a talk, like I am now, and there is a smart audience in front of you, bright lights beaming down. If I had an amped-up threat bias, I would very quickly and intensely notice that there is this one person in the audience who is frowning, shaking his or her head, maybe falling asleep. I will fail to notice all the interested and smiling faces in the audience, and get stuck on this person. The natural result – I feel more anxious and stressed, I am on the look-out for further negative information, and I ignore positive evidence that I’m doing a good job.

In this way, the threat bias drives the vicious cycle of stress and anxiety, takes up mental bandwidth, and puts us at a disadvantage when there is no real danger to face, when the monsters in the closet are only in our mind.

Personal Zen

Now, this threat bias doesn’t sound so great. Not great at all. But I love the threat bias and other cognitive biases. That is because there is an empowering message hidden in the idea of cognitive biases. Biases are essentially habits. When we have a bad habit, we are not broken inside – to change, we just need to learn a new habit.

So I have spent a good part of my 20-year career studying how we can derail cognitive biases like the threat bias, learn new habits to heal the anxious brain, and translate these techniques into a digital format.

Over these 20 years as a researcher, I’ve done all the things that a researcher is supposed to do, and enjoyed the process: received grants, run dozens of studies, published over fifty scientific papers on everything from the emotional lives of children to the neuroscience of the anxious brain, became a full, tenured professor at the City University of New York, where I founded the Emotion Regulation Lab, The Center for Stress, Anxiety and Resilience, and the Center for Health Technology and Wellness.

But I only really began to make progress and question how my research on cognitive biases was making a difference when I was pregnant with my daughter. I was talking to my husband about how I felt stuck, and that maternity leave was going to be my chance to think outside the box and he says, “Why don’t you build an app for that?” An app, I said – that’s ridiculous. There are too many “apps for that,” ugh.

But, he got me thinking that maybe this really was a way to do things differently.

Enter attention bias modification, a technique I study in my lab and that takes the threat bias and turns it on its head. Attention bias modification sounds a little like this:

clockwork orange

But I promise you, it’s not. Attention bias modification uses simple computerized techniques to rebalance the scales of attention to create a new habit of preferring and prioritizing the positive over the negative. It is perfectly suited to digital and mobile technology because it’s brief, cheap & easily accessible, and doesn’t require a shrink.

I’ve created an app called Personal Zen that embeds these techniques into an engaging, on-the-go format. Here is how it works – We see both an angry and pleasant sprite quickly pop up in a field of grass. The sprites then burrow down into the field, but only the pleasant sprite leaves a trail of grass. Our task is to trace that windy trail. Because the angry and pleasant sprite appear at exactly the same time, our brain is forced to figure out what to pay attention to. By ALWAYS following the trail of the pleasant sprite, our brains learn to automatically focus on the positive and disengage from the negative. We start building a new habit of attention. Follow the joy.

Picture1

It’s deceptively simplistic, but clinical trials show that using Personal Zen and the attention bias modification techniques it is based on effectively rewires our brains to disengage from the negative and focus more on the positive – and this translates into reducing stress and anxiety after as little as single use of the app.

The Politics of Technology and Fear

So Personal Zen is a technology-based way to help heal the anxious brain. Yet, I simultaneously believe that the digital technology culture as it stands now is also one of the most surefire ways to amp UP the threat bias and make our anxious brains worse.

We mediate our lives through mobile and digital technology – we know this, it’s how we filter the tremendous complexity of our lives. But we are living in an attention economy in which news organizations, businesses, and our social networks are constantly pinging, ringing, and texting us, competing for our rapidly dwindling bandwidth of attention. We are on a digital mental treadmill. Corporations spend millions figuring out how to best keep us on that treadmill by high jacking and seducing our emotional brains, how to reward us, titillate us, and scare us into looking, clicking, buying, eyeballs on the screen, and how to mine, use, and sell our personal data.

The politics of fear are finding fertile soil in this attention economy, with fear-mongering politicians using these same techniques to drive opinion and votes, to amp up our anxieties and fears. The only good voter is an anxious voter.

The digital mental health field as it stands is not much better. There are thousands of mental health apps on the market, but fewer than 1% have ANY scientific evidence base. So, it’s essentially the Wild West, full of snake oil salesmen. This is tough on us consumers. How do we find the signal in the noise? The FTC’s crackdown on digital brain training companies like Lumosity, which was fined millions for unfounded medical claims, is a sign of the times.

The Future is Now

But let’s turn to the future.

It is crucial that at this key moment in time, we envision a new and revolutionary future for the role of technology in health. That future has to be now, and we have no time to waste. The digital technology culture in which health care is evolving is consciously and relentlessly designed to brain hack, co-opting our anxious brains, our addicted brains, our bored and restless brains. We have to disrupt the digital disruption of our lives.

Don’t get me wrong, the human race has been brain hacking for millennia, shaping and mediating how we view and make sense of reality – through language, religion, the arts, politics, education…. Along come radical advances in digital computing and now we have another tool – but it is a tool that should NOT be privileged above others. And we must take a cold, hard look at how in some contexts, the costs of these digital tools outweigh the benefits, leading to information overload, greater anxiety, and social disconnection.

So I say, let’s step off the digital mental treadmill. We all know ways to do this, ways as simple as silencing the endless rings and buzzes of our notifications, turning off our devices during meals with our family and friends, and minimizing the time as family, parents, and friends, our loved ones see the back of our devices rather than our faces. When we take these steps, we treat our attention as sacred and precious, as a resource to be spent wisely. These values must be front and center when we design and use health technology.

I challenge all of us today to reclaim technology to heal the anxious brain and heal the culture of fear: Designers, help us streamline screen time – less time with eyeballs on the screen – and design technology that facilitate our ability to live truly connected and fulfilling lives; Consumers, demand digital health tools with scientific backing and be conscious of how you’re spending your precious, precious attention; Politicians, draw on the best rather than the worst aspects of the attention economy. The only good voter is an informed voter. If we do these things, together, we will create the tools we need.

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.

 

 

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?