Mobile Phone App: 'Therapist In Your Pocket'

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Courtesy of Dr. Margaret Morris

Dr. Margaret Morris at Intel Corp. is designing a cell phone app to help manage stress in everyday life, in order to improve mental health and reduce the risk of cardiovascular disease. Morris calls the app "Mobile Therapy."

Sophisticated mobile phone apps are being developed and tested around the world for use in the mental health field. Some of the applications include: help quitting smoking, treating anxiety and detecting relapses in people who have psychotic disorders like schizophrenia.

According to researcher Mark Boschen of Griffith University in Queensland, Australia, the computing power of mobile phones allows them to be used as part of psychotherapy for several mental health problems.

"Some of the applications include things like attempts to quit smoking, the treatment of anxiety and for picking up the early warning signs of relapse in people who have psychotic disorders like schizophrenia," Boschen says.

Dr. Margaret Morris, a clinical psychologist working at Intel Corp., is designing a cell phone app to help manage stress in everyday life, in order to improve mental health and reduce the risk of cardiovascular disease.

Morris calls the app she's developing "Mobile Therapy," and it can be downloaded onto most cell phones.

Here's how it works: Throughout the day at random times, a mood map pops up on the phone's screen. "People drag a little red dot around that screen with their finger to indicate their current mood," Morris says. In addition to reporting on mood, a patient can chart their energy levels, sleep patterns and activities, the food they've eaten and more.

Based on all that information, she says, "the phone app offers therapeutic exercises. These range from breathing visualizations to progressive muscle relaxation," to useful ways to disengage from a stressful situation.

The information captured on the app can later be charted, printed out and reviewed. The idea is that the person can look at a whole week of mood data to see if there are any connections between one's mood and other factors happening in one's life and record it into the app.

The app has been beta-tested in 60 people so far.

"Everyone who used it described new insights about their emotional variability" and said it helped reduce their stress, Morris says.

Her research was recently published in the Journal of Medical Internet Research. She writes that by using the Mobile Therapy app, participants were able to increase "self-awareness in moments of stress, develop insights about their emotional patterns and practice new strategies for modulating stress reactions."

Alan Delahunty, a psychotherapist from Galway, Ireland, treats teenagers suffering from clinical depression with a proven effective therapy called "cognitive behavioral therapy," or CBT. An essential component of CBT is "homework," which involves patients keeping a daily diary, charting their moods, energy levels, sleep, activities, etc.

Typically, patients will bring their paper charts into their therapist to discuss them during their weekly therapy session. But many patients -- especially teens -- balk at doing the CBT homework, and many stop doing it.

Previous research suggests that patients who do their CBT homework assignments and practice them between sessions are the ones who benefit the most and benefit the most quickly.

Knowing this, researchers Gavin Doherty and Mark Matthews at Trinity College in Dublin developed a cell phone app that's being tested by a couple of dozen therapists throughout Ireland.

Delahunty, one of the testers of the "mobile mood diary," says it's a very useful tool.

"From a clinical point of view, I've found it a huge improvement over the pen-and-paper technique," Delahunty says. He adds that his young patients love the app and rarely miss doing their daily homework.

They're pleasantly surprised that they can use their cell phones to help themselves in therapy. And when they come into therapy, he says, "You get a complete printout of their mood, their energy level, their sleep patterns, and any comments they've made over the week or two. And then you can put that down on the table in front of you, and use it to discuss the therapy with the young person."

Because teens are so comfortable with texting, Delahunty adds, "I'm getting more comments. And in some cases, it's really like narrative therapy, where you'd be getting a paragraph of text for each day, which brings out a richness in the therapy situation that you can explore then."

Psychiatrists, too, find the mobile mood diary a benefit by looking at the graphs, monitoring the young person's moods. "That was helpful to them, in deciding whether the young person should be on medication or change their dosage or whatever because it [the mobile mood diary] was a very accurate measurement of how the young person's mood was moving," Delahunty says.

Another mental health app under development is called CBT MobilWork.

Judy Callan, a researcher at the University of Pittsburgh, is developing it in collaboration with computer scientists at Carnegie Mellon University. This phone app has CBT homework designed specifically for adults with severe depression.

Callan describes how a typical patient might use it: "Say a patient starts therapy and they're really depressed and they can hardly get out of bed. One of their homework assignments might be to, each day, just make the bed." Once the patient has successfully accomplished that task, the homework on the cell phone app will change, prompting and coaching the patient to take the next step.

Thus this app, like the other mental health apps, expands the hour-a-week therapy session into a 24-7 mobile therapist. Callan hopes to adapt her phone app to be used in anxiety, phobias, eating disorders and other mental health programs.

One of the most intractable mental illnesses, afflicting 1 percent of the population, is schizophrenia. It's for these patients that University of Pennsylvania researcher Dimitri Perivoliotis is developing innovative mobile technologies -- palm-sized computers that chart a patient's moods and activities, for example; and a digital watch that has personalized scrolling messages. The messages on the watch can instruct the patient on stress reduction exercises, like deep breathing or muscle relaxation, in order "to reduce the stress triggered by their voices," Perivoliotis says.

"One of our patients came in with chronic, constant auditory hallucinations that really controlled his life," Perivoliotis recalls. "The voices would threaten him that if he would go outside and do fun things, then terrible, catastrophic things would happen to him. He felt really enslaved by them. He felt no sense of control whatsoever."

So the therapist taught the patient a few simple behavioral exercises to reduce the severity of the voices. It's an exercise called the "look, point and name technique," Perivoliotis explains. "When a patient starts to hear voices, he applies the technique by looking at an object in the room, pointing to it and naming it aloud. He repeats this until he runs out of things to name."

Perivoliotis says "the technique usually results in reduced voice severity [i.e., the voices seem quieter or pause altogether], probably because the patient's attention is redirected away from them and because speaking competes with a brain mechanism involved in auditory hallucinations."

So the mobile therapy watch that this patient wore was programmed to remind him a few times a day to practice this technique to control the voices.

"It really did the trick," Perivoliotis says. The voices were dramatically reduced. "It kind of broke him out of the stream of voices and his internal preoccupation with them."

Exercises like these not only give the patient temporary relief from distressing symptoms but also, importantly, "they help to correct patients' inaccurate and dysfunctional beliefs about their symptoms -- from, 'I have no control over the voices,' to, 'I do have some control over them,' " Perivoliotis says.

As a therapist treating patients with schizophrenia, Perivoliotis finds the mobile technologies extremely useful.

"It gives me an additional source of rich information of what the patient's life is like between sessions," he says. "It's almost like an electronic therapist, in a way, or a therapist in your pocket." Copyright 2010 National Public Radio. To see more, visit http://www.npr.org/.

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