Adjunctive Mobile Technologies for CBT: Part 3 Ryan Hansen, M.S. Ohio State University

A very important question: Why?

Good Reasons: Interactivity Reminders Proximity Navigation of Information Communication Psychoeducation

Bad Reasons: To replace therapists To duplicate worksheets To duplicate webpages

What is an App?

Smartphone Market Share

The Mathew Effect in Market Share Android and iOS Dominate Less incentive for developers to make apps for other markets Fewer Apps in other markets Less reason to buy other phones Android and iOS Dominate

Operating Systems are like Languages IOSAndroid

IOS Objective C (Free) X-Code (Free) *need a mac with OS 10 or higher iOS Developer Program ($99/Year) Must use Developer Certificate in Testing Submission to App Store Apple gets a cut of all sales and subscriptions

Android Java (Free) Eclipse (Free) Can test apps without account Submit to Google Play (One time $25 fee, instantaneous publishing) Google Play gets a cut of all sales and subscriptions

Websites are Like Interpreters

HTML5 Free (but requires hosting) No software needed, but it helps No curated market (both good and bad) Able to work offline (if bookmarked) Able to access many features on newer devices Sandboxed No Fees attached Public doesn’t understand it

Native Wrappers Phonegap Titanium appMobi Create native apps using HTML5 Provide API’s (Hooks to get out of the sandbox) Work across platforms (mostly) Can be submitted to app stores

Limitations of Native Wrappers Integration with SDK’s (like Google Analytics) Efficiency Memory Leaks/Garbage Collection Problems Difficult to orchestrate large projects Poor Documentation

Hiring Someone Else Apps are expensive ($5,000-$30,000) Look at their portfolio Can you talk to them in plain English? How will you maintain the app? How will you host the app? Pitfalls of hiring students/neighbors/nieces Longer production Not knowing what you don’t know Hit by a truck?

DIY apps High learning curve Simpler is better HTML5/Javascript is the easiest language to learn Google can help Follow the examples online and modify them Plan out your app on paper first Spend time on User Interface Design Write out all the functions in plain English first. Test it on as many phones as possible

App Creation Demonstration

4.01 Maintaining Confidentiality Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. Confidentiality

Security Where is the data stored? Locally Password Protection? Encryption? Backed up on iTunes/internet? Texting? Viruses? Remotely How is it getting there? HTTP vs HTTPS WiFi vs Cell Connection How is it stored there? What is their privacy policy? How secure are their servers? How much information do they have about your client? Is your location or IP being tracked?

The Real Danger: Hackers vs Lawyers

Ethical Questions What if your client is tracking illegal activity? HIPPA Does it fall under the FDA? “Suicidal Siri” What data is collected by the app about the client? Who is that data shared with? Advertising?

Legal Considerations Does your employer own the app? What liability goes along with making and distributing an app? What liability goes along with recommending an app or using it in therapy?

Gamification Zombies, Run! Endomondo

Suicide Prevention Apps ASK Guard Your Buddy RUOK:OSU

ASK PlatformsiOS, Android PriceFree CreatorMental Health America of Texas User Rating3.5 Stars Features:National Hotline # Warning Signs How to Ask Hotlines Veterans LGBTQ Internet Resources

ASK BestClean, Efficient Layout Easy Navigation Clear Content WorstLack of Telephone Link on Opening Page Lots of Text Research BaseNo Formal Research

Guard Your Buddy PlatformsiOS, Android PriceFree CreatorTennessee National Guard, Parthenon PublishingParthenon Publishing User Rating4.5 Stars Features:Get Help Now Warning Signs How to Help Do’s/Don’ts Internet Resources Veterans Families Money Feelings Rascal Flatts Pledge

BestProfessional Design Easy Navigation Concise Text WorstVeteran Specific Limited Info In-App Links to website, which does not load in iOS Research BaseNo Formal Research Guard Your Buddy

RUOK:OSU PlatformsiOS, Android, HTML5 PriceFree CreatorOSU Suicide Prevention User RatingNot Rated Features:Local Crisis Line (Ohio) National Hotline # Campus Police # Warning Signs How to Ask Share the App (QR) Special Populations LGBTQ Veterans Spanish TTY OSU Resources

BestUses User’s Location Provides OSU and National Resources WorstText-heavy OSU Specific Content Only Ohio Crisis Lines Research BaseNo Formal Research RUOK:OSU

PTSD PTSD Coach PECoach

PTSD Coach PlatformsiOS, Android PriceFree CreatorNational Center for PTSD, National Center for Telehealth and Technology. User Rating4 Stars Features:Psychoeducation PTSD Therapy Assessment and Symptom Tracking Symptom Management Tools Support Network Professional Referral Information

BestBoth text and multimedia Tools for symptom tracking Tools for symptom management Rating distress before and after interventions WorstBug in Manage Symptoms Assessment only Tracks Total Score Research Base No formal research, uses many techniques from Prolonged Exposure and CBT PTSD Coach

PECoach PlatformsiOS, Android PriceFree CreatorNational Center for PTSD, National Center for Telehealth and Technology. User Rating4.5 Stars Features:Psychoeducation Record Therapy Sessions Appointment Reminders Breathing Retraining Suds Anchors Symptom Assessment (PCL) Security Settings

BestBoth text and multimedia Tools for symptom tracking Recording Sessions Recording Exposure Exercises Security Settings WorstCant delete recordings Rigid Structure Research Base No formal research, Uses techniques from Prolonged Exposure PECoach

DBT Diary Card and Skills Coach PlatformsiOS only Price$4.99 CreatorDurham DBT inc. User Rating4.5 Stars Features:Diary Card Skills Targets Notes Extensive Coaching Dialogues 911 Skills Distress Tolerance Mindfulness Emotion Interpersonal Skills DBT Reference

BestProfessional Design Easy to Navigate Highly Customizable Uses Apps and Music for Distraction Password Protected Diary Card WorstLots of small text Research Base No formal research, Designed to be incorporated into DBT treatment DBT Diary Card and Skills Coach

LiveHappy PlatformsiOS only Price$0.99 CreatorSignal Patterns, Dr. Sonja Lyubomirsky User Rating3 Stars Features:Savoring Activities Social Activities Acts of Kindness Developing Support Network Strive (Goal Setting) Gratitude Journal Optimism Psychoeducation on Positive Psychology

BestProfessional Design Simple to use Multimedia WorstRelatively Few Features Complaints of Bugs/Instability Slow streaming with videos Research Base No formal research, Uses practices supported by research in Positive Psychology LiveHappy