Quantified Self Apps For Mental Health

I have commented on various developments in the “quantified self” arena, including sensor based feedback  and mobile apps such as H(app)athon. These ideas are an interesting mix of groundbreaking possibilities, disappointing efforts, and hype.

In this great age of selfies and social media, it is inevitable that the impersonal, thought-free, personality destroying technology of the small screen would be deployed in the pursuit of feeling good. Last year I blogged about the H(app)athon project, which applies the concept of quantified self to try to track and improve “happiness” (based on the Psychology of Happiness, which is a real, if imperfect, thing.) Whatever the merits of the overall program, the app itself was disappointing, interrupting life to make you fill in self-reported subjective feelings.

Moodnotes from Ustwo and Thriveport  is a new app in the same vein. Underpinned by Cognitive Behavioral Therapy (not quite the same as “Happiness Psychology”), the idea is to use a mobile phone to trigger some of the kinds of conversations that occur cognitive behavioral therapy. Given that much of the therapeutic “work” is accomplished by self-discovery in CBT, this isn’t a totally impossible idea.

Caveat: this app is only available for iOS (and, apparently, the Apple Watch as well), so I can’t try it myself (I have no iOS, and never will.)

From the description on the web pages and from Liz Stinson’s description in Wired.com, you interrupt your day to interact with the app. “The app walks users through a series of actions, which serve as those road signs. These actions, which begin with manipulating Mr. Face [to report your mood], become progressively more introspective as you progress through the app.”

You record your mood, and log some statements about recent thoughts. It also does some guidance about “thought patterns” such as CB therapists do, e.g., to identify “traps”, habits that might limit or undermine your thinking. When this technique works, it helps people think positively and generally not talk themselves into a hole.

As in other behavior tracking systems with or without mobile apps, interrupting your daily life in order to do the questions is less than optimal. The app designers comment that “Normally we design applications to be as cognitively light as possible—this one is very heavy in terms of cognitive effort.” (Alana Wood of Ustwo, quoted in Wired.com). In other words, this is an unusual app, in that it deliberately demands a lot of attention, and is supposed to sometimes be uncomfortable.

Design query: given the purpose and design of this app, how in the world can it really work on an Apple Watch? I have no idea.

While this is an unusual feature for the “swipe here” culture of the mobile social world, it is central to Cognitive Behavioral Therapy. “[I]t’s this intentional struggle that leads to insight and learning” (Edrick Dorian of Ustwo,quoted in Wired.com).

Will this or any other app actually make you happier? No one knows at this point. My bet is that some people will like it, most won’t have the patience to use it, and it might even be bad for some people.

CBT is particularly helpful for people who are troubled by, say, taking criticism too personally. Learning new options to see the same events in different ways, including positive ones, can make a huge difference. Could having an app that helps you “talk to yourself” about the world help? I can imagine that it might for some people.

On the other hand, some people benefit from having the personal mentoring from the human therapist, which is missing from the app. I would predict that some people, especially older people, do not take their mobile seriously, and might not invest the effort needed to benefit.  “Its just a stupid app—what does it know or care about me”.

Finally, there may be some people who are actually harmed by this kind of app. For example, if you are already deep into screen addiction, I’m not sure that even the most carefully guided conversation will help you with the bigger problem that you don’t know how to operate in human society. (With any self-therapy, there is a risk that you are treating yourself for the wrong disease, no?) Sitting in your room doing “mood therapy” with an app is the last thing I want to see you doing. Get out there and talk to real people, face to face.

Social psychological digression: It is interesting to compare the H(app)athon app to the Moodnotes app. While these two apps have similar user interactions, and similar goals, they have substantially different philosophical emphases. The H(app)athon app comes from a school that focuses on behaviors that make us happy, especially altruistic behavior. Helping others makes you happy. In contrast, Moodnotes uses a Cognitive Behavioral approach is focused on subjective interpretation of events and behavior, particularly verbal statements about yourself. You can make yourself unhappy (and even ill) by framing life negatively, and vice versa. It’s not all about you, but you can make life hell if you tell yourself that it is.

So, the two apps will look similar, and both will have similar “quantified self” style tracking (e.g., you can get charts and reports and other annoying goop out of them), and both make you stop living and type on the small screen. But the kinds of stuff they track will be totally different. The H(app)athon app will track volunteer work that you do, the Moodnotes will track what you say about interactions with your boss. Apples and oranges.

This looks like a fertile area for careful research. Do these apps work at all—what outcomes can be demonstrated? How do they compare to other modes (face to face, other kinds of instruments)? Can we incorporate sensor data (e.g., measures that should correlate to anxiety)? What kinds of things can tracking are most effective for? Who will be helped, not helped, or potentially harmed?

Assuming this works at all, how should such apps be designed?

We shall see.

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