Check out my blog post for Psychology Today, in which I discuss whether we need the concept of Human Downgrading, promoted by the Center for Humane Technology, to prevent the advent of future dystopias. How about Human Upgrading, instead?….
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:
- 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. This 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.
- 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.
- 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.
- 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.
I think a lot about how our use of digital technology, social media, and mobile devices shapes how we feel, think, and behave; shapes our muscles and our memories. There is no doubt about the host of benefits afforded us by all of these technologies, but their costs are both obvious and hidden.
We know that sometimes we feel addicted to them. We know we devote an immense amount of time and attention to them. Although they should be working for us, we often feel that we are working for them. We may even feel more tired and stressed and discouraged after being on screens. Muscles tense, furrowed brows. No one feels free on screens.The cult of efficiency tells us that we can and must get more done.
We are learning more about the consciously addictive designs of these technologies, mobile devices in particular. They are meant to hook us in. We now have no doubt that our views and clicks, our “data”, are the basis of the attention and surveillance economy, a multi-multi-billion dollar behemoth of an industry. As a psychologist and neuroscience researcher, I think about states of mind and brain when we use these devices, mobile phones in particular.
So, in the great tradition of obsessive scientists throughout history, I have been conducting an experiment on myself. Instead of using my mobile device on my daily
subway commute, I now take a little notebook, about the size and shape of a small mobile device, and write poetry.
Some of the poetry is about my personal experience of technology, but most is not. The goal of the experiment is to track my subjective experience and assess how my state of mind changes when I think in poetry, express ideas in verse, write with a pen instead of click, swipe, click, swipe. No goals. Free-flowing thoughts. Efficiency the last thing on my mind.
Here are the poems I’ve written so far. I’m still collecting data. I’ll report back later in the summer and post more poems as I go.
If anyone wishes to join me in this experiment, please do so! Post your poems in the comments and I’ll post them on the blog (attributing them to you, the author, of course).
The Subway Poems
Show Instead of tell
I raise my hand
I talk to you and forget
What you said
Only half remember what I said
I wonder, in the flood, what is really worth saving
What happens when we suddenly start listening,
When we pay
Small conversations: “I’m here”; “I know what you want”
My husband holds the coffee cup
Shifting in its saucer
Zooming in on a screen
Except nothing like that
The opposite of a two-dimensional half-life
On the screen, our bodies shrink,
Contained in our headbox
Eyes and ears
Holding our breath
A laser pointer, robot madmen
Eyes created to gather information
Punch! Punch! Check off, check off!
We have made ourselves into the image of small people
Stuck in the trees, no forest views though they cry, “disrupt!” “innovate!”
Victims who have become victors
Powerful like sad, awkward puppeteers
Are you my kind?
Two of a kind, a kind of wonder
Kind of this and kind of that
Kinship is a slippery slope
An avalanche of decency
One step forward and three…
A tango, a pas de deux
Eliminate the excess
“i carry your heart with me(i carry it in
Anywhere I go
I am in a land of others, of those who are not
Kinship being a slick and clever bird
Oil-slick and floundering
As little friction as possible
Same in skin, same in heart, same in bones
A tribe of potentiality
The tip of the spear
The Tip of the Spear
The world seems full of tips of spears
Doing the bidding of the savages
I imagine a spear with a stone arrowhead
Bound with twine or
(am I making it up that people did this?…)
Animal guts or entrails
The tip of the spear is bound tightly as a
Clenched fist and
As a dream from which
You can’t awake
As tightly as hope
When you have nothing left
Building blocks totter
Sculpture of Chinese letters
Hold the pen tightly
Woman on Subway
We are all subjects in the kingdom of randomness
Among our uncertain narratives
Hard pressed to find a story that we can live by,
That we can inhabit
How could the vast indifference,
The imperfect glazed bowl
Of our universe
Not make sense?
Can’t you see the spark in every
Rose and thistle
In every question and it’s too certain answer?
So long ago, I can’t remember
The inferno is hard to explain to a child
It assumes knowledge that is like a quagmire
Every step deeper in
But more lost
Sucking, slurping, sticky marsh goo
They should come to know that they will be judged
And, if not found wanting,
That they will dance away from the platform edges, and eventually embark
Towards a destination
If My Life Were Staged by a Puppeteer
(After watching Basil Twist’s SYMPhonie FANTAStique at HERE, NYC, Spring, 2018)
Puppeteers are underrated
We deride them as marionette-obsessed,
As hopeful that the world won’t see the strings
But I have seen puppeteers who perform
Wet suits slick
With dreaming fishes
And sparkle scarves
Twisting round so they are
In perfect time
With the daydreams
Of a lovelorn
How quaint it is to convince someone
That they are valued
We all know that our value
In bits and bytes
Our very eyeballs and fingers,
What they see and click and swipe…
The delight of pirates and dragons
How can we doubt this?
And doubting, how can we then
Reach beyond ourselves to figure out
Like playing an arcane card game with high stakes
The Babylonians discovered zero 400 years before Christ
But our distant, round companion
Doesn’t glow with a soft light
Is neither a satisfying ellipse
Nor a road to travel,
Neither a portal, nor a golden and flaming hoop,
Which we jump through and into and beyond
Zero is absolute
A closed door
A set point
An off switch
Zero is not infinitely possible
Zero is an unsheltering sky
The California Poems (New Poems Added 7/19/2018 After Having Visited California)
Boy in band
Then dust motes singeing tracks of light
You do not know that you are glowing
You think the light on your keyboard is merely ambient
But, my boy, light is not empty-transparent
I want you to know the wonder of frenetic photons
Lustrous and linking you to the seemingly tiny red giant
The white dwarf
The wheeling double black hole, bending space-time
Tiny pinprick across galaxies opening rifts
For cosmic rays to wriggle through
On stage now
No thought of the universal
Or of cosmic scales and endings
Just the moment
Darling boy, you do not know that you are glowing
You turn to the crowd and speak into the microphone
You showed me how to gallop down east 15th street
Making sure to stop two cracks back from the corner
Like we showed you when you were three years old
“Faster mama, like this”
Hair streaming behind you
A wily shadow
“Can I tell you something?” you asked, when I caught up
Then singing to yourself, skipped away
A jubilant stone on still water
Lately your body has become long and solid
It makes me think of sand packed firm along the shore
Yet still fragile
Softening with the tides
This summer you started to think about
The kind of person you are with other people
“I’m not shy“ you tell me
And I have to agree
But I see you, sweetheart, the many layers of you
A nautilus shell with inner swirls of glass and cloud
I think you know that you are seen and
Like to try on different suits, covered with concoctions of mirrors
I love to see them all
In Morro Bay
You carved your initials on a juicy, round cactus
Excited that you also wrote a T for me
Marking that we were together
Even though I sat, warm, in the car
Sheltered from the mist and wind swirling about the throat of the distracted volcano
where you played
In a storm, the world outside is temperate and ordered
A Bach etude
Soft moss under feet
Even the eye of the storm is never truly still
It both exceeds and falls short of our well-worn reference points
It is like a slumbering archetype,
A shadowy ideal
Our fear of storms requires no explanation
“For beauty is nothing but the beginning of terror“
But awe is not selfless admiration
It is the last shred of dignity and the relief
That comes from knowing
You do not yet have to say yes to the truly still point above the fray
This talk by developer, entrepreneur, speaker, and social critic Maciej Ceglowski is a must-read primer for _everyone_ on the ethics of digital technology.
These are rapidly changing times, in part due to the frenetic pace of technological innovation. How we communicate, connect, love, hate, and elect presidents are forever altered. Given this, educators, parents, and corporations are focusing on cultivating 21st century skills – skills like problem solving, synthesizing information, interpreting, collaboration, and kindness. These are skills that prepare us for the increasingly complex life and work environments of the 21st century, and reflect the changing nature of work, communication, and how we use technology to facilitate our lives.
I believe that of these, kindness is the most critical 21st century skill, whether your goal is a civil society or successful business. Kindness is at the hub of our pro-social selves and is the glue of civilization. It allows us to understand the world through another’s eyes and act meaningfully in that world.
What is kindness? Kindness means interacting with others in friendly, generous, and thoughtful ways. It means performing acts to benefit others without expectation of reward or benefit for oneself.
For that reason, forcing acts of kindness sabotages the motivation to be kind, and a display of good manners does not automatically mean that a person is kind. Good manners can exist in the absence of generosity and thoughtfulness, and can be motivated by the hope of reward and praise.
Kindness is distinct from other, related aspect of our pro-social selves. For example, sympathy refers to the concern for and understanding of someone else’s distress, feeling pity toward the misfortune of another, especially those perceived as suffering unfairly. In contrast, empathy is the capacity to experience what another person is experiencing, including thoughts, emotions, and sensations, all from the other person’s frame of reference. It leads to an attuned response from the observer. And compassion, perhaps the pinnacle of our pro-social self, is empathic and sympathetic awareness of another’s suffering coupled with the drive to alleviate it. Think Mother Theresa, although compassion does not need to be that elevated, complete, or grand.
So, kindness is at the hub of all these aspects of our pro-social selves. Kindness does not emerge out of a vacuum nor is it innate. Kindness instead is the result of core, crucial skills and capacities that lay the foundation for kind behavior and kindness as a moral compass. These capacities of the sine qua non of our pro-social selves: perspective taking, emotion regulation, moral reasoning, and modeling. Each of these skills allows kindness to emerge, and without them is impossible.
Here, I want to focus just on perspective taking. Perspective taking is the ability to put oneself in another person’s shoes, to understand that someone might think and feel differently than you do. Perspective taking allows us to feel sympathy and empathy.
In Psychology, perspective taking is part and parcel of Theory of Mind, which describes how we have a latent “theory” or belief about how the world works. This theory assumes that other people have minds, and that these minds think and feel and believe things that are distinct from what we think, believe and feel. In disorders such as Autism Spectrum Disorder, where social understanding is disrupted, Theory of Mind and perspective taking may not develop fully or in ways that we see in typical development. In very young children, Theory of Mind and perspective taking is evident when a toddler plays a trick on someone, or surprises someone. To be surprised, one must not know something that another person does know. They must have their own mind.
In our current political climate in the U.S. as well as nations all over the world, kindness and civility appear to be crumbling. Xenophobia and “us versus them” thinking is ascendant. One of the most effective ways to combat this, I believe, is to practice perspective taking, make a habit of trying to understand what and why a person might be experiencing the world in the way that they do. Practicing perspective taking will nourish kindness in us all.
With the election less than two weeks away, we’re revisiting a previous post on “Politics and the Culture of Fear: Is There a Place for Digital Disruption?”:
It feels as if we can’t escape the culture of fear and extremism that is pervading politics. Political discourse is more vitriolic than ever after San Bernardino and Paris, and during the months of partisan name-calling and ugly mud-slinging among candidates for the U.S. Presidential Race. And clearly, there are no easy solutions to unraveling this vicious cycle.
During the Christmas holiday, I had an experience that perfectly illustrated this to me. My family and I were at a friend’s house for a holiday event, and I overheard her guests talking as I walked through the kitchen. I heard, “The more he says, the more I like him.” Then, “He says the things we all think but are afraid to say.” I started to get that sick feeling in the pit of my stomach, hoping they weren’t talking about Donald Trump. Then I heard, “The only problem with building a wall between Mexico and the U.S. is that it will have to be so big that it’s impractical and expensive.” I tried to talk myself off the ledge, saying to myself, “Don’t open your mouth, just keep walking, don’t say anything, it won’t help or change anyone’s mind…..” But then as I was about to turn the corner, safely avoiding a conversation that would surely have turned ugly, I heard, “Of course we should ban Muslims from entering the country. Look what they did in Paris.” So, I turned sharply on my heel and unwisely marched over to the little group sitting around the kitchen table.
“Excuse me,” I said, “but I couldn’t help but overhear your conversation, and I wish that you would consider the fact that excluding or persecuting people solely on the basis of their religion or ethnicity is how (voice rising) the Holocaust started.” And then, when the response to that grenade lob was dropped jaws and the explanation, “It would only be temporary,” I looked at them incredulously, probably with disgust on my face, and said, “That’s what Hitler said and” just in case they didn’t get it the first time, “that’s how the Holocaust started.” Then I abruptly left, muttering, “This was a mistake, I can’t talk about this…..”
I found this conversation terrifying – not only because the thought of Trump as President is terrifying, nor because I was disappointed in myself because I lost my cool, and created an extreme, unbridgeable divide between our viewpoints by invoking the Holocaust. No, this conversation was most terrifying because these people were not bad people. They were the type of people I appreciate: good, kind, hard-working people who love their kids and their family.
So where does that leave us?
I don’t have a solution, and indeed, my own extreme reaction during the kitchen table conversation shows that I lack objectivity and am certainly part of the problem. I do, however, as a scientist believe that we can harness what we know about our minds and brains to neutralize this vicious cycle of social and political extremism. Could digital disruption help move us along a path to such change? There might not be an app for that, but below I list three steps I believe could put us on the road towards digital disruption of the political culture of fear.
1. Frame political extremism as an emotion regulation problem. Before any digital disruption can happen, we have to make sense of the problem and have a concept of what’s going wrong. We have all had one of those kitchen table conversations I described above. In these conversations, our emotions get the better of us – fear, disgust, anger. This is a problem in how we control our emotions and how our emotions control our thoughts, decisions, and actions – something psychologists call emotion regulation. The problem is that our strong emotions rarely convince our debating partners. Instead, they solidify the views everyone already holds, causing us to cling to them even more strongly and rigidly. Common ground is lost, and the divide between perspectives seems increasingly unbridgeable.
Imagine how a version of that kitchen table conversation happens on the political world stage, sabotaging attempts at diplomacy and mutual understanding. The result is not just upset and angry people. Now the result is that our emotions directly shape political discourse, legal decisions, and policies that can affect generations to come.
Thus, a first crucial step towards disruption of the political culture of fear is to frame political discourse in terms of emotion regulation – applying what we know about what goes wrong and how to fix it on the individual and group level.
2. Use technology to promote empathy. Recent research in political psychology suggests that empathy can help heal rancorous political divides. A recently-published study showed that when political advocates fail to understand the values of those they wish to persuade, this “moral empathy gap” causes their arguments to fail. However, when political arguments are reframed in the moral terms of the other side, they are more effective. For example, when asked about their views on universal healthcare, conservatives who heard “purity arguments” (e.g., sick people are disgusting and therefore we need to reduce sickness) were friendlier towards universal healthcare, compared to when they heard “fairness arguments,” which are more consistent with liberal values.
If we can use technology to bridge the moral empathy gap, we might be able to reduce political polarization and promote better emotion regulation, more compromise, and deepened understanding. Virtual Reality (VR) might be one such technology. I previously wrote about Chris Milk’s thought-provoking TED talk on VR as the “ultimate empathy machine.” By creating a sense of presence and of real interactions with people and worlds, VR forges empathic bridges leading to greater understanding and compassion. In his work with the UN, Chris Milk uses VR to vividly portray the plight of refugees to politicians and policy makers. How does seeing and experiencing the suffering of 5-year-old children in the refugee camps influence policy making?: Almost certainly for the better.
3. Use technology to calm the fearful brain. As political ideologies become increasingly polarized, neuroscience research suggests that the differences between liberal and conservative viewpoints may extend beyond policy preferences to fundamental differences in the “fearful brain.”
In a paper I wrote in 2014 with Dave Amodio, a professor at NYU, we found that children of liberal compared to conservative parents showed a stronger “N2” brain response to mildly threatening and conflicting information. A greater N2, derived from EEG, suggests more openness to uncertainty, ambiguity, and threat. A culture of fear, in politics or otherwise, is marked by the opposite of this: inflexibility and discomfort in the face of uncertainty and ambiguity, along with resistance to change. These aspects of fear are part of the foundation upon which intolerance is built.
What if we could create computerized interventions that promote our ability to cope with uncertainty and change – perhaps by strengthening the N2 response? My research on the stress reduction app Personal Zen, as well as other research, shows that this may be possible. More research is needed, but if science-driven digital mental health continues to evolve, reducing the political culture of fear could soon be in the palm of our hand.
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:
- 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?
- 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:
- 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.
- 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.
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.
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
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” 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.
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]]
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.
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:
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.
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.
Picture this. A recruiter is reviewing job applications. There are two applicants who have the same area of expertise, identical levels of experience, and equally great letters of recommendation. One of them is named Jane, and one of them is named John. The recruiter has to decide without meeting them who to hire, who is the most competent and capable.
Research shows that the recruiter is more likely to hire John, just on the basis of his being a John rather than a Jane. This research further suggests that you and I might do the same, whether or not we are a man or woman making the decision.
This largely invisible bias is but one example of what women face in the workforce. How do we deal with these implicit and subtle biases – let alone with the egregious and explicit misogyny that still exists? Some have touted the concept coined by Facebook COO Sheryl Sandberg, “Lean In” as a solution.
I want to argue here that “Leaning In” is exactly NOT the way to combat bias against women in the workforce or elsewhere. I also want to contrast it with an alternate concept I’ve developed called Precisionism, which I’ve written about here.
Let’s start with Lean In. Sheryl Sandburg parlayed her TED talk on why we have too few women leaders into a book call “Lean In: Women, Work, and the Will to Lead”, and then into a Lean In movement. The focus of Lean In is on “… encouraging women to pursue their ambitions, and changing the conversation from what we can’t do to what we can do.” Yet almost immediately upon its release, Lean In was critiqued as “faux feminism” with The Guardian going so far as to refer to Lean In as “an infantilising, reactionary guide for ambitious women.”
Moreover, Bell Hooks in her critique “Dig Deep: Beyond Lean In” argues that Lean In ignores “the concrete systemic obstacles most women face inside the workforce and fails to call for much-needed social change, instead providing women advice on how to become successful within existing conditions.” In this sense, she argues that Sandberg’s stance on gender equality in the workplace is “agreeable to those who wield power in our society – wealthy white men – in a seemingly feminist package….”
One of my favorite quotes on the Lean In ideology is this comment from software engineer Kete Heddleston: “Women in tech are the canary in the coal mine. Normally when the canary in the coal mine starts dying you know the environment is toxic and you should get the hell out. Instead, the tech industry is looking at the canary, wondering why it can’t breathe, saying “Lean in, canary. Lean in!” When one canary dies they get a new one because getting more canaries is how you fix the lack of canaries, right? Except the problem is that there isn’t enough oxygen in the coal mine, not that there are too few canaries.”
Sandberg herself acknowledged that she didn’t truly understand the plight of single moms who cannot blithely Lean In, who do not have the extreme economic advantages that she herself enjoys.
Enter Precisionism. The basic premise of Precisionism is that many women possess a deeply-rooted drive for excellence that is different from the way men are socialized to pursue excellence. I call this drive for excellence Precisionism because while it shares some aspects of perfectionism, it does not involve unrealistically high standards or feelings of failure. Instead, a Precisionist assumes that s/he is good enough to strive towards the highest standard of excellence, even if it is never quite reached. A Precisionist has the capacity to go deep, to focus on getting the details right and noticing what others fail to notice. A Precisionist sees patterns that others miss, and draws on intuition to transcend current limitations and think outside the box. A Precisionist also knows that mistakes are an opportunity for growth. A psychologist, Harriet Braiker, got to the heart of this when she wrote: “Striving for excellence motivates you. Striving for perfection is demoralizing.”
Therefore, women should NOT model themselves after predominant, male models of how to succeed, lead, and work effectively. Instead, women should set new standards and capitalize on their unique drive for excellence.
Although Lean In tells women to fight for their seat at the table, the underlying message is that to do so we have to accommodate the status quo. Precisionism in contrast, like the seminal punk rock album ‘Never Mind the Bollocks: Here’s the Sex Pistols’ tells us to disrupt long-held beliefs and to be ready with an open mind for something new. Let’s be ready for new ideas about what makes a person a great leader, powerful, and valuable.
So, ladies, never mind Lean In. It’s precisely the right time for new perspectives on how to take a seat at the table – and to do so by being the ones who set the agenda and lead the conversation.