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.

Appily Ever After?

I was very interested to read this funny take  on psychology smartphone apps in the New York Times (by Judith Newman) – or more accurately, how NOT to build a psychology app. I just blogged about this general topic in my last post, and what struck me most about this article was the notion of time.

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Art by Emily Flake (published in the New York Times 4/5/2013)

This article seems to suggest that mental health apps should quickly and effortlessly facilitate our relationships, efficiency, and well-being. As Newman writes in the article:  “All of these apps require thought. Lots and lots of thought. Thinking is what I do all day long. I needed something that would turn my mind off, not on.”

Great point. Maybe we don’t want the app to be our shrink – because when we go to a therapist, we tend to have a set of expectations that involve spending a good deal of time and energy (unless we’re just looking for a medication fix). Apps, by their nature, are fast, easy, and mobile. So, most of us expect that a psychology app will be a shortcut to mental health. We shouldn’t have to spend time learning how to use the app or being on it too much – at least not so much that it’s taking away from “having a life.”

This view tells me that there is a potentially deep disconnect here: between what many of us in the mental health field think of as the promise of mobile health technologies and what everyone else thinks. Many psychologists see a future in which apps and computerized therapeutic tools break down barriers to treatment, which can be too expensive and intensive for many. For example, for the most common class of psychiatric disorder, the anxiety disorders, only about 20% of anxious people receive treatment! So, the psychologists are thinking, jeez, mobile technologies offer so many amazing possibilities for integrating mental health treatment into the daily life of people who are suffering.  Let’s create an app for that!

But we need to think through our approach carefully. If we just put the same old (frankly boring) computerized interventions on smartphones, will that actually help us reach more people? How many will choose to use these tools? Maybe some, but perhaps not many. Perhaps what most of us want from an app is the digital and interactive version of the self-help book – you can take it or leave it,  pick it up and put it down after a few minutes and still get something from it, and which doesn’t feel like just another source of techno-burden.

So, what is the take-home message for the mental health professionals? Make it fun, make it fast, and make it effective or get back to work on making traditional treatments better.