OCD Manager

I've just finished playing with a free account on MockFlow.com and made a mockup sketch of a diagnostic app for OCD.

Often in class we've talked about people suffering from OCD as lacking a sense of accomplishment for tasks, so they redo them, making a ritual around them to try and make it feel right. My teacher, Prof Dar, would say that in such a case even love becomes a question of accomplishment - how do I know that I love someone? Is it because we're married? Because she makes me laugh? In this way life is reduced to something we would expect to find on The SIMS, Second Life, or our Facebook life - places filled with events that replace authentic feelings. How do you know you love on FAcebook? By your Likes and your relationship status. Well, then maybe people suffering from OCD can benefit from social gaming dynamics in the same way.

The OCD manager is meant to facilitate a common CBT homework assignment - keeping record of rituals and repeating thoughts. It could also help people suffering from OCD manage their rituals, by logging what they've just done, but much cooler would be if reducing life into events, would emulate the lacking sense of accomplishment.

Tell me what you think :)

http://www.slideshare.net/orushka/ocd-manager

I saw some guy stole my name for the app and is now selling his understanding of it in itunes. It's not as good as my idea but still, may he die of OCD.

Mobile psychotherapy study + my wishes for biometrics sensors, behavioral trackers and AI analytics...

I just read this article by Margaret E Morris from Intel's Digital HEalth Group. It describes a study of 5 cases, of patients using mobile phones that assess their moods, offer interventions such as relaxation techniques and questions that help change negative interpretations. With this, once a week the patients/users had an interview in which a therapist reviewed their data with them and suggested routine solutions to recurrent problems. The studied cases showed improvement.

It seems the researchers got a few things very right:

1) Online assessment - If you want to change a person's behavior you need to map it. How to map it is a question of technology. Brick-and-mortar clinics require the patient to report what he remembers of his behaviors and cognitions in retrospect, and such reports, from outside an intense emotional experience, may suffer from distortion of perspective and rationalization.

2) Online Therapy - traditional psychotherapy requires a leap from the sofa to real life. A patient given a relaxation technique must be able to work it when it is relevant in his routine life. The traditional therapeutic idea of here and now, is what we currently refer to as online. Interventions are given when they are needed.

3) Data mining methodology -  As scholastic bible interpretations take in little data and make whole doctrines by it, so do therapists often take single incidents and observations and induce into principles. This situation was forced by time limitations, a patient's unwilingness or inability to tell it like it is, or just the barriers of language. However, in the age of information technology, data is superfluous and analysis usually means a data reduction funnel - making simple conclusions based on a lot of complex data. The described analysis that was described in the research could be viewed as data mining, and could be broadened to take in much more sets of data on the patient.

4) Mapping cause and affect - What the weekly analytic session provided the patients, was a link between events and their emotional effect. These are the two basic components of CBT. If a person could become aware of how events and situations prompt behavioral and cognitive responses, and more importantly that these are contingent with other responses, then a conscience change would be facilitated. In the article, the example was that a man who used to fight with his family when he came back from work noticed his energy dropped right after work, so he was advised by a therapist to take a pause for relaxation before getting out of the car.

I wish these points would be developed in the future:

1) More tracking and sensor based data - The device described in the study asked the patient/user to assess his own state and reply on diagnotic questions. this takes time and means that the device has to ask at certain time intervals or the user needs to turn to the device for assessment. I wish more tracking and sensor based data was available. If the patient's heart rate variability would indicate his arousal state, or if a phone tracker would would indicate that at a specific moment was talking on the phone with his wife, or even that in the conversation the speakers were interrupting each other's speech or that the trigger words "get milk" were mentioned... well, then there would be a lot more data to use and to relate to. But more importantly, a lot of the data would reflect aspects of the event that are not part of the patient's perception of the event, and may help bring a broader set of data into the patient's attention and help the patient "see it coming" and be prepared for an aversive situation.

2) Artificial Intelligence Analytics - when more data would be available, it would be harder for a human analyst to contain it. Artificial neuron networks can handle such capacities of data and make statisticly predictivve generalizations. What is more important, and will probably be the Nobel worthy discovery in all this post, is that they will rely less on pre concieved hypotheses and more on empirical findings. They may come to conclusions that humans, as sensitive as they maybe, are prone to overlook. Of course machine learning is also prone here or there. 

3) Sharing - Instead of having the therapist providing ideas and solutions, an experience sharing network could be created. People can learn from each other how to solve problems. For example: "67% percent of people of people who are asked to buy milk at lunch feel stressed during the rest of the day, 90% of them felt better by setting a reminder on their mobile, 10% of them got to feel better by having a long open talk with their life partner about personal space." Well, wouldn't you want to know that?

Illustration:

Ref:

Morris ME, Kathawala Q, Leen TK, Gorenstein EE, Guilak F, Labhard M, Deleeuw W
Mobile Therapy: Case Study Evaluations of a Cell Phone Application for Emotional Self-Awareness
J Med Internet Res 2010;12(2):e10
URL: http://www.jmir.org/2010/2/e10/
doi: 10.2196/jmir.1371
PMID: 20439251

How to: start an online industry

I'm on my way to work, reading this old article about online therapy by Michael Fenichel* on the bus, and feeling like something is missing here. The writer of the article tries to translate the face to face psychotherapy principles to those that would apply online. For example, he asks whether the font of an online therapy chat could be interpreted as transference. Well I don't know. Really, I guess it depends on many things. But theorizing about it won't give you the answer either.

In my view, online therapy is not the same craft, not the same industry. Applying psychoanalytic techniques is a good way to miss the point.

I think what needs to be done is a theoretic definition of goals (stuff like improve well being), red lines of abuse (privacy etc.), and then, since my bus has arrived at work, a good technical oprationalization of measurements. I mean, ways to check that goals are achieved and red lines are avoided. Anything in the middle, such as font size in therapy chat - that can be measured accordingly.

Gotta go!

*Not  to be confused with Otto Fenichel.

From therapy session to online therapy

I believe the idea of a therapy session is a technical one. When Freud had patients of independent means (that have tons of money) he had 5 sessions a week for a few years, when it's part of public health care insurance (poor folks), it's become 30 sessions tops, and the patient is announced that most work is done between sessions. 

Brick and mortar clinics, are rooms with couches and people, that you have to come to, and meet face to face. I believe they act as bottlenecks in a lot of cases, as the question of matching the best specialist to the most needing patient, becomes a financial and geographic matter. Online therapy offers a lot of people access to therapy. 

Reading the state of the art literature on online therapy makes me feel like there's a big lag in the definition of "online" compared to other services. I mean, when you say that you get your news online, do you mean that you get it on your computer screen instead of on paper? Or do you, perhaps, mean that you get it all the time? Or maybe even, that  you are connected with tons of current content updates relevant to where you are, what you buy and what you do?

Same goes for online psychotherapy. It is not only that we can reduce the cost of couches and waiting rooms. Not even that a specialist can be accessible around the world. It's some app that tells you that since you started yoga, your anxiety levels lowered consistently, and that people who benefited from yoga like you, also found similar benefits in calling grandma. All this without a session.

*This is where someone shows me I've missed something great and fantastic in my research.

TeleHealth protocol: treating PTSD with PE via Skype

I like this approach. I am thinking about Therapy on Demand channels,  iphone apps etc...

2 quote from the article:

method:

"when patients had difficulty beginning in vivo exercises on their own, it was helpful for the patients to complete the exercise while talking to the clinician on a cell phone."

conclusions:

"Prolonged Exposure therapy via telehealth technology was associated with large reductions in symptoms of  PTSD and depression for veterans diagnosed with combat-related PTSD. In the current sample, telehealth PE treatment was safe and pragmatically viable. Treatment noncompletion rates, although higher than average for our clinic, were in the acceptable range."

(Tuerk et al., Journal of Traumatic Stress, Vol. 23, No. 1, February 2010, pp. 116–123)

Looks like people are doing it. skype therapy I mean...