"Remember kids, the difference between screwing around and science is writing it down"
This famous quote from Myth-Busters highlights how critical measurement and documentation is for science. As our national conversation about mental health shifts towards science-based awareness, Mr. Savage's words have a deeper wisdom in the age of the smartphone.
The goal of mental health treatment is to empower those suffering from dysfunctional brains with tools and skills. Equipped with these, they can then better manage their conditions to live a happy and healthy life full of meaning. When we think about this treatment process, we typically think about weekly therapy sessions, antidepressant medications, stress-reduction strategies, and going running for the sake of our brains. An often overlooked, yet critical part of the treatment process is assessment. After all, how do you treat something that you don't understand and how do you know if things are improving if you don't have a metric for success? Ironically, Mr. Savage's quote is quite literal when it comes to mental health assessment, as the most common assessment tool used is writing down the results of an interview with a client. If your therapist is more sophisticated, they might give you a questionnaire to fill out (again literally writing things down). Only the most cutting edge of clinics will leverage technology by digitizing this questionnaire into a form you fill out on a tablet-computer assisted writing down of things!
Unfortunately, this glacier slow adoption of technology has led to huge barriers in access for mental health assessment services. This is perhaps most apparent with neuropsychological assessment. To make inferences about brain functioning, neuropsychological assessments usually have a very large focus on cognition (i.e. attention, memory, etc,) and have a very large price tag. Based on quotes from The Canadian Psychological Association 1, a typical 5-hour assessment could cost up to $1000, which results in restricted access and long wait times for these procedures. Indeed, The University of Calgary's Foothills Medical Center reports an average wait time of 1-3 weeks for inpatient assessments, with out-patient assessments having wait times as long as 6 months 2. This access issue is only going to get worse as reduced stigma for mental health leads to an increase in demand, with rural and indigenous communities being among the most under-served populations. As a result, there is an urgent and growing need for a new approach to assess brain functioning and mental health.
Thankfully, the technology to mitigate this access barrier already exists. Unfortunately, the technology is primarily used to sell us things that we don't really need. Without getting into the ethics of the many big tech companies' business models, it is to their advantage to leverage the vast amounts of data they can collect on people to personalize shopping suggestions and content recommendations to your unique tastes. Who hasn't found the Facebook ads just a little too creepily accurate at times and I love when Amazon sends emails to remind you to buy recently viewed items. Tragically, mental health issues are often associated with social media an online shopping addictions 3, meaning that the most vulnerable among us fall victim to these algorithms. Just imagine how much more wonderful life would be if Siri instead used all of your Iphone data to recommend a short guided meditation when it detected a decline in mental health.
Neuroscientists have just begun to explore how we can transform our relationships with technology for the better. For example, one study used an app to assess people's smoking risk and sent them push notifications with personalized quitting messages (instead of Breaking News Updates) 4. A key benefit of these app-based mental health services is that they effectively automate much of the process and can be used remotely, allowing the services to be administered at much lower prices and to a much wider group of people, such as traditionally undeserved rural communities. Perhaps no single mental health service needs this revolution more than neuropsychological assessments, as the wait lists and costs listed above indicate. Indeed, I recently published a paper 5 that outlines how smartphone technology could not only permit remote and automated assessment of mental health to reduce accessibility barriers, but also improve the precision of those assessments. By moving beyond simply "writing it down," and instead using smartphone technology to its full capability, mental health treatments can be better personalized to a person's unique situation. The wealth of data collected on us on a daily basis could be used to help identify what aspects of our lives, from social relationships, to certain work out routines, to dietary experimentation, best boost our mental health. Armed with this information, everyone could receive personalized feedback about how to promote their brain to work at its best.
Did you know you can ask the author of a science article for a copy of their paper and they can give you a personal copy for FREE? Since I recently published an article on mobile phone technology in cognitive assessment, email me for a copy and feel free to ask any questions you have about the science.
...about how brain assessment could make better placebo effects
...about how mindfulness could fit into all this
...about commercial-grade neurotechnology that could be used for remote brain assessments
3. Anderson, E. L., Steen, E., & Stavropoulos, V. (2017). Internet use and Problematic Internet Use: A systematic review of longitudinal research trends in adolescence and emergent adulthood. International Journal of Adolescence and Youth, 22(4), 430-454.
4. Hébert, E. T., Stevens, E. M., Frank, S. G., Kendzor, D. E., Wetter, D. W., Zvolensky, M. J., ... & Businelle, M. S. (2018). An ecological momentary intervention for smoking cessation: the associations of just-in-time, tailored messages with lapse risk factors. Addictive behaviors, 78, 30-35.