February 14, 2012

Depression, There's an App for That

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Joseph V. Madia, MD By:

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Innovative new technologies such as smart phones and virtual coaches help more people manage depression

In today's fast-moving world of technology, it's perhaps no surprise that resources and treatment for mental health are catching up with high-tech.

New "virtual therapist" technologies are providing novel approaches for treatment. From smart phones and web-based applications to a medicine bottle that "talks" to you and your doctor, mental health treatments are hitting the cutting edge.

At the new Center for Behavioral Intervention Technologies at Northwestern University, scientists have invented a smart phone that intuits when you're depressed, and will nudge you to go out or to call a friend.

In what Northwestern calls the "future of therapy," the phone and similar technologies bypass traditional weekly therapy sessions for innovative new approaches that provide immediate intervention—and are able to support a much larger population.

"Technological advances like these offer innovative ways to supplement and increase access to care," says Nicole Meise, Ph.D. "Just as modern technology has enabled diabetics to monitor and regulate their blood sugar (glucose) at home, these tools empower individuals to take a more proactive role in their own well being."

Smart Phone Reads your Mood

The smart phone technology, called Mobilyze!, is able to interpret symptoms of depression via a sensor that picks up a person's location, activity level, mood and social contest. After the phone learns a user's typical patterns, it detects when calls or emails go down or the person is sitting home alone for hours, isolated.

It then sends suggestions for reaching out to others. The technology is still being tweaked, but testing in a small pilot study showed that the phone helped reduce symptoms of depression.

“By prompting people to increase behaviors that are pleasurable or rewarding, we believe that Mobilyze! will improve mood,” said psychologist David Mohr, director of CBIT. “It creates a positive feedback loop. Someone is encouraged to see friends, then enjoys himself and wants to do it again. Ruminating alone at home has the opposite effect and causes a downward spiral.”

Medicine Bottle with a Mobile App

The string-around-the-finger method is a time-worn, and often fallible, way of remembering things. When it comes to taking medicine, staying on track can be vitally important.

A new medicine bottle in development at CBIT is able to track a patient's daily dose of antidepressant medication, and issue a reminder if you forget. It not only acts as a daily alarm, but addresses the very common problem of patients who quickly stop taking the antidepressants prescribed by their doctor.

“People whose depression is being treated by primary care doctors often don’t do very well, partly because patients don’t take their medications and partly because the doctors don’t follow up as frequently as they should to optimize the medication and dosage when necessary,” Mohr said. “This pill dispenser addresses both issues.”

The bottle includes a mobile app that monitors the patient's depressive symptoms, as well as possible side effects of the medication, and provides advice tailored to manage problems. Using the MedLink system, the smart bottle then sends this information to the health care provider along with any recommendation to dosage or medication. The MedLink system can also improve medication adherence for patients on drug treatment for schizophrenia and HIV.

Virtual Coaches for Teens

Social skills are an important part of managing depression, and for young people it can be especially challenging to master. Another CBIT technology is a virtual, programmable human that is able to role-play with adolescents and young adults, to teach them assertiveness and other social skills that can help combat their depression.

Existing online interventions for teenagers are too much like homework, Mohr said, whereas this new technology is much more like an interactive game which engages young people. A prototype is currently being developed in partnership with researchers at the University of Southern California. The CBIT lab will be evaluating a number of different challenging social interactions that could be used in the virtual coach, to help patients practice and deal with them.

Improving social skills and confidence is important because having trouble in those areas makes people more prone to depression. “When people have the confidence and skills to better manage difficult interpersonal interactions, they are less likely to become depressed," Mohr said. Previous research also has shown that intervening early in adolescents who have difficulty with social skills can help prevent the first onset of depression.

Online Coaching for Cancer Survivors

For people who have successfully battled cancer, stress and depression are common by-products. A new web-based coaching program can help cancer survivors manage their stress and depressive symptoms, by utilizing the Internet content along with a real human coach who checks on their progress via phone and e-mail.

When people know that someone they like or respect is monitoring them, they are more likely to stick with such an online program. Mohr's CBIT group is creating a closed social network and collaborative learning environment, where peers can serve in that coaching and support function for each other.

This would enable them to share their goals, get feedback from other group members, and check in with other members if they have not been active in the group.

“We’re inventing new ways technology can help people with mental health problems,” Mohr said. “The potential to reduce or even prevent depression is enormous.” Mohr adds that the new inventions could offer treatment to people who are unable to access traditional services, or who are uncomfortable with standard psychotherapy. There are also significant cost savings.

"Although I'm not certain we will ever be able to fully replace the benefits of seeking help from a trained mental health professional, I could certainly see utilizing these tools in my practice," says Meise. "Using technological advances to facilitate and increase access to treatment is beneficial to both the patient and doctor."

The goal is for CBIT to become a national resource, offering a library of intervention technologies that will be available to other researchers. The center is funded by the National Institutes of Health.

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Reviewed by: 
Joseph V. Madia, MD
Last Updated:
February 14, 2012