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Integrating Mobile Technologies into Mental Health Treatment

Integrating Mobile Technologies into Mental Health Treatment. Frederick Muench , Ph.D. fm2418@columbia.edu fred@healthtxts.com. Disclosures. Owner: Mobile Health Interventions: Text messaging company for health services and research. In the process of “selling” company.

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Integrating Mobile Technologies into Mental Health Treatment

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  1. Integrating Mobile TechnologiesintoMental Health Treatment Frederick Muench, Ph.D. fm2418@columbia.edu fred@healthtxts.com

  2. Disclosures • Owner: Mobile Health Interventions: Text messaging company for health services and research. In the process of “selling” company. • Consultant: Several mobile health companies, none of which are mentioned in this presentation.

  3. Mobile Adoption • 83-95% mobile phone use, including low income & disenfranchised groups • 98% are SMS ready • 50% smart phone adoption based on SES, expected to skyrocket • Mobile internet users will reach 113.9 million in 2012, up 17.1% from 97.3 million in 2011 • By 2014, mobile will become the most common way of accessing the Internet • Use driven by age – not SES • No Digital Divide • 90% of individuals in intensive government subsidized outpatient substance abuse care had an active mobile phone • *19-26% of mobile users use their phone for health (mostly fitness). *MR 2012, Pew, 2012

  4. Why Mobile? • What, Why, How, When & Where 24/7 access to increase salience of change goals in-vivo: • Assess & monitor using multiple mediums (active & passive) • Tailor & intervene/adapt care (just-in-time) • Triage & crisis intervention • Network with supports • An extension IBIs • Data Download • Improve data quality, display and monitoring, EMR integration, dashboards, research, etc. • High level of client acceptability in mobile - clients want to stay connected • Mobile combines “safe distance,” but continued monitoring

  5. Top 10 Health Searches: 2011 Web Searches: Cancer Diabetes Symptom Pain Weight Infection Virus Diet Thyroid Sleep Mobile Searches: Chlamydia Bipolar disorder Depression Smoking/quit smoking Herpes Gout Scabies Multiple Sclerosis Pregnancy Vitamin A

  6. Empirical Data It’s coming….. I promise Very little on mobile applications: • Pilot studies on development with small N’s By far, the most on text-messaging: • High acceptability, appointment adherence • HIV medication adherence • Depression • Smoking & Alcohol Use • Weight loss • Diabetes & Asthma monitoring Mobile assessment – the one place we are ahead of the game!

  7. “Agile” Research Designs (Hekler, 2012)

  8. Capabilities Built Into Smart Phones

  9. Capabilities…

  10. Stand Alone Apps • There are also numerous applications that attempt to provide overlapping services as therapists and specifically highlight CBT theory such as iCBT, ICouchCBT, eCBT, CBT Referee, eCBTMood, CBT Clam, iCounselor • Other apps including things like PTSD Coach with four modules focused on 1) education, 2) self-assessment, 3) symptom management, and 4) social support. • Stand-alone apps work well with consumers who are highly motivated but cannot afford treatment. • Dr. Boudreau will perform a full review next

  11. Self Tracking/Goal Setting General Apps Behavior Tracker Pro DatahabitDaytumTallyZoo “Mood-Tracking” Apps Mood ScopeT2 Mood TrackerMood PandaMoody MeMood Swing Goal-Setting Apps Use similar techniques, but focus on goal-directed behaviors Habit FactorLivifi

  12. Self-Monitoring isEssential for Change 2.04 Bases for Scientific and Professional Judgments: • Psychologists' work is based upon established scientific and professional knowledge of the discipline (See also Standards, 2.01e, Boundaries of Competence, and 10.01b, Informed Consent to Therapy) Self-monitoring is one of the most highly effective behavior change techniques across behavior change domains (Michie et al. 2009; 2012; Webb et al. 2011).

  13. The biggest problem is….

  14. Therapists Matter Homework and self monitoring are enhanced when there is accountability. Mohr, D. C., Cuijpers, P., & Lehman, K. (2011)

  15. TallyZoo Example:

  16. Sensing….

  17. Passive Sensing • Activity Monitoring • Fitbit, Nike Plus, Body Media, etc. • Sleep • Zeo Personal Sleep Coach, Sleep Stream 2 Smart Alarm Clock, Sleep Cycle • GPS, Geolocation (Behavioral Activation) • MapMyTracks.com, endomondo, InstaMapper, CHESS • Passive sensing – using features embedded in the phone • BeWell

  18. Dashboards Can Keep You Connected

  19. Client Centered Accelerometer Temperature sensor Galvanic skin response sensor Heat flux sensor

  20. As social as you want it to be….

  21. Obstacles • Cost • Limited empirical data • Confidentiality & Privacy • Scope of Practice • Reimbursement • Consent • Real-Time Emergencies • Hardware limitations/malfunctions • Lost phones/devices • multiple numbers in short-periods of time • Limited proactive use by individual • Individual privacy concerns • HIPAA • FDA

  22. Thank You Questions fm2148@columbia.edu

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