Those technologies, which include a mobile phone that encourages users to call a friend when it knows they're feeling down, are in development at the Center for Behavioral Integration Technologies (CBITs) at Northwestern's Feinberg School of Medicine. The center, which was inaugurated this past September and received funding from the National Institutes of Health, combines mental health support strategies with technology to create web-based, mobile and digital intervention systems. Other projects include a social network for cancer patients, a virtual social skills coach for teens and a medicine bottle that keeps track of patients' adherence to prescriptions.
"These technologies move the treatment out of the therapist's office and into the lives of these people," says David Mohr, director of the center and a professor of preventative medicine. "If you have a mobile phone application, it allows it to intervene with you in real time, providing the user with support when they need it."
The smart phone technology, known as Mobylize!, is loaded with sensors such as a GPS, light monitors, microphones and accelerometers, all of which provide information about the user's environment. The Mobylize! pilot study matched the data with context by polling participants with major depressive disorders several times a day about where they were, whom they were with and what they were doing. The result was a series of individualized prediction models that learn and identify what situations contribute to depression and what behaviors make people feel better. If social activity helps a patient, the phone will send the user a message prompting them to call a friend or get out of the house if he or she has been alone for an extended period of time.
"We found that it significantly improved their mood," Mohr says.
Though Mobylize! is about applying technology outside of face-to-face therapy, the project is not meant to be a substitute for traditional care.
"There are a lot of clinicians who get distressed by terms like 'therapist in your pocket' because it sounds like we're replacing the human connection," says Jennifer Duffecy, the intervention development core leader for CBITs. "That's the last thing I would recommend. It's about how to provide additional help and assistance in the moment they need it. We can't be with patients 24/7, and this provides a bridge so that people can get care when they need it."
Mobylize! isn't just about following up with patients when they're not meeting with their therapists, though. It's also about increasing access to care on a larger scale: Because web-based or mobile intervention services cost less and require less support, they have the potential to reach a population whose needs aren't always met. Mohr says 7-10 percent of the U.S. suffers from a depressive disorder, and more than 25 percent is estimated to be able to benefit from therapy – numbers that current mental health care resources can't support.
"There's no way that therapists or our health care delivery stream can serve that number of people," Mohr says. "We have a person problem, so devising ways to treat people effectively or potential first line treatments has the potential for a significant public health impact."
Originally, the CBITs team conceived the project as a tool to assist people excluded from traditional health care due to factors that prevent them from seeking treatment, such as a lack of transportation or inadequate child care. But Duffecy says anecdotal accounts from participants revealed a group of patients who surprisingly didn't have trouble getting therapy, but never wanted it in the first place.
"We said it was an online intervention and got all these people who reported to us they would never have sought care," Duffecy says. "They could get care if they wanted to, they just weren't interested in that. It surprised us and made us realize that there was a large group of people who needed care, but weren't getting it and said, 'I have problems, but traditional methods aren't appropriate for me.'"
The initial trial of Mobylize! was completed a few months ago, but CBITs is in the second phase of retooling the device and plans in the coming months to do more field and usability testing. Though the original trial was successful, showing significant increases in patients' moods, the models can still be fine-tuned to better learn and understand the patients' habits and behaviors.
"If I log my mood whenever I'm at work or at the coffee shop or at my home, I can make educated guesses about how work or home makes me feel," says Mark Begale, the technology core leader at CBITs. "But it's more complicated than that. I could be at a coffee shop with my friend. Or I could be at home watching a movie. We're making that system better at guessing by learning new techniques by applying new sensors."
Although CBITs focuses on mental health, interest in the applications of technology to other areas in health care is growing, with what Mohr says is a boom in research by the National Institutes of Health as well as the private sector. There's potential for incorporating similar responsive technology into obesity management, illness prevention, treatment adherence or other forms of wellness.
"Your doctors aren't going to be with you all the time to say, 'Hey, eat your green beans,'" Begale says. "But your phone can."