1. Integrating Mobile Technologies into Mental 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 Its coming….. I promise Very little on mobile applications: Pilot studies on development with small Ns 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 Wireless Data AccessReal-time analysis and feedback Apps & Mobile WebConnectivity to data, providers and social support Speedy ProcessingTailored personalized Medicine – just-in-time Device add-onsDiagnostics

9. Capabilities… Voice & TextIVR, Reminders, Contact, interactive, decision support, emotional tone, recognition Camera/VideoTelepsych, modeling, environmental monitoring Accelerometers/ActivityBehavioral activation, Relapse, Side effects, Sleep GPS, GISTriggers, Activity scheduling, etc. Galvanic Skin Response, Temperature, Heart Rate Variability Predict outcome, Relapse, Side effects

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. General Apps Behavior Tracker Pro Datahabit Daytum TallyZooDaytum 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 Self Tracking/Goal Setting

12. 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). Self-Monitoring is Essential for Change

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:

17. Sensing….

18. 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 Passive Sensing

19. Dashboards Can Keep You Connected

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

21. As social as you want it to be….

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

23. Questions fm2148@columbia.edu Thank You