(light pleasant music)
- Today I would like to talk to you about technology
for health and wellbeing, but primarily I'll be focusing
on technology for mental health,
although we do work in both areas.
So, we've done a lot of health applications over the years.
I've been working in this space for about eight years now.
We actually started looking at depression and stress.
We targeted stress primarily because,
when you start reading the stress literature
and you learn how bad stress is for you,
it makes you super stressed out (laughs).
So I remember, the first summer
I started reading that literature,
my heart was palpitating all summer
because it leads to obesity, it leads to heart disease
and you gain weight in your stomach,
you have shoulder issues, back issues,
all these bad things happen.
So I thought it was a pretty important thing to focus on.
And a lot of people understand that stress causes problems,
but they don't actually know how to manage it.
So, everyone has stress in their lives,
but most of us don't have the healthy ways
of coping with stress.
We haven't learned them
because we really didn't need to as we were growing up.
So, a lot of people may know they should exercise.
Maybe they do yoga, maybe you drink alcohol (light laugh)
to relieve stress or smoke cigarettes.
But there are actually really easy interventions,
is what we call them, or skills or practices,
to relieve stress that most of us just haven't learned.
So we set out to try to teach people what those are.
Now, we started in a funny way.
We started externalizing your stress.
So we designed a lot of things that you can see here,
from wearables like a vest that has hackles
that, when you get stressed,
it gets really sharp in the back,
or little devices you could put on your desk
that showed when you were stressed out,
to even a butterfly that flapped its wings
harder and harder the more stressed out you got,
which was actually the opposite of the way
we should have designed that (laughs)
'cause it made you really stressed out (laughter).
We even designed wallpaper that got really crinkly
and ugly and loud and red
when you got stressed out in the room.
All of these things, these externalizations of stress,
were actually not so good.
So, we moved towards actually putting these skills
that we wanted to teach people on the phone
and moved away from wearables.
And, the first application we did was a simple application
that just helped people in the workplace learn
when they needed to actually maybe get up, take a walk,
go get a drink of water, take a bio break, talk to a friend,
and we actually did this just in time.
So we learned, when you got stressed out at work
and started to recognize that automatically,
and then automatically sent you a skilled practice,
so that you would be less stressed out.
And people enjoyed that very much.
Now, we've moved on
to doing real psychological interventions
or skills that people can practice
that come from the field of psychology.
We did two different things.
One was, with psychologists, we learned
how to use things people do on their phones anyway.
So, you're gonna go to Facebook anyway,
or Instagram anyway, or Pinterest anyway.
Is there something there that we could teach you
that would help you feel less stressed out?
So, let's just say, from positive psychology,
there's a well-known intervention,
it's called writing down three things you're thankful for.
It actually works, it makes you feel better.
Well, if you're going to Facebook,
why not go to Facebook and look for three things
you're thankful for in your Facebook feed?
And people actually will do that.
Instead of going mindlessly to Facebook and grazing,
you can actually go with a purpose, and it actually works.
So that was one kind of intervention that we learned
to provide to people that people were willing to do,
and that they really liked doing.
Then, out of the blue, about two years ago, I was contacted
by Doctor Marsha Linehan from the University of Washington.
She has a therapy called dialectical behavior therapy,
it's a mouthful, but DBT.
And it's a therapy that prevents suicide, primarily.
It's a very well-known therapy.
It pulls from Eastern medicine, mindfulness training,
but also real psychological interventions.
And she wanted us to put it on the smart phone
and give it out to people for free.
Millions of people have suicidal ideation or thoughts,
and they can't get help.
Plus, there are very few licensed therapists,
licensed therapists who really know how to do DBT,
and people are waiting in line to get this kind of therapy.
So we thought, if we could put it the smart phone,
we might really be able to help people.
We started doing other kinds of interventions.
We actually did one application
for parents of children with ADHD.
It's a well-known, especially for males.
Young boys get diagnosed with ADHD a lot.
It's a kind of hyperactivity, and what we did was,
we had parents wear bracelets and, when we sensed arousal
in the parent's bracelet, we would send an intervention
to the phone and to a display on the wall in the house.
And this taught parents things that they had been told
by their therapist that they should be doing
to model good behavior for their children,
but in the heat of the moment,
when the child's having a meltdown, they forget.
So, just by using a simple sensor and the phone,
we are able to teach parents good behaviors
to model for their children.
Actually, two years later,
we've seen that the parents are still using this app.
Even without the sensor, they just like seeing
what they're supposed to be doing
when their kids have a meltdown.
So that was our first application.
And I think the reason it worked so well
is because we had really good design.
So, the interventions or the skills
we were teaching the parents were beautiful to look at,
and they were beautiful on the display.
For the parents, on the phone,
we actually had the words of what they were supposed to do,
but on the wall where the children could see
the intervention being displayed, we took the words out.
The parents just had to remember
what that intervention was.
So the child, who could probably read at this age,
didn't know that they were actually getting an intervention,
telling them what to do.
And that was quite successful.
However, as we moved to trying to do this DBT therapy
with Doctor Marsha Linehan,
we realized that just seeing an image
and a skill that you're supposed to practice wasn't enough.
We actually needed a conversation.
Just like when you go to see a psychologist,
you have a communication with that psychologist,
you have therapy, and it goes back and forth.
So we moved towards trying to do emotion regulation
with a conversational UI.
And we've learned a lot
about user interfaces for conversations,
especially in this area of mental health.
So the first thing is that it has to be very attractive.
As I said, design is key.
It has to engaging, or people are not gonna use it.
But, secondly, you have to have this conversation
with someone you really trust,
someone who seems very professional.
The other thing we've seen is,
if the agent that you're conversing with is very attractive,
that works well too.
But in this case, we had Doctor Marsha Linehan,
why not use Doctor Marsha Linehan?
She's famous, people who are in DBT therapy
really know who she is.
She's like a rock star for therapy.
So we decided to try using Marsha.
So, dialectical behavior therapy
really is just a way of learning skills
that help you cope when you're feeling super stressed out,
or when you think you might just want to end it all.
And it's a very systematic therapy, you learn it stepwise.
so we had to design the application in a similar way
just like if you were going through the therapy.
So that's what we did.
And it's really just all about
learning the skills step-by-step,
and it starts with mindfulness,
and then it goes to emotion regulation,
and then there are diction skills and other kinds of skills.
And the good and the bad, as I said before,
is it works really, really well.
It's well-validated, hundreds and hundreds of studies.
It's worldwide acknowledged
to be the best prevention for suicide.
However, as I said, it's expensive,
so those that can't afford it can't get access to it.
There are too few licensed therapists to work with,
and a lot of people who have suicidal ideation
are actually embarrassed to go seek help.
So, if we could put this on an app on a phone
that they could have with them all the time,
this might be the way to succeed.
So, we decided to go mobile to reduce these barriers
to treatment and put all of her therapy on a smart phone.
But her therapy was aging a little bit,
so we were very lucky.
We got one of Marsha's PhD students, Chelsey Wilks,
to join our team as an intern,
and she modernized it using this conversational UI
and making the therapy wording a little more accessible
to younger folks and just to everybody.
So, it was the lowest common denominator.
And we wanted to use machine learning
to see what really worked and what didn't.
Interestingly enough, Marsha didn't actually know
which areas of her therapy
worked really well for which people.
So, if you had borderline personality disorder,
which is very hard to treat,
were there certain parts of DBT
that worked really well for those people?
Or, if you just had generalized anxiety,
were certain parts better?
She didn't know.
So this was the first time we were actually able to track
what people did with an app using DBT
and see what really worked for them.
So this is Doctor Marsha Linehan.
We turned her into eMarsha (laughs).
She actually, she saw the app for the first time
two days ago, and she said, man, you even made me look good.
I don't know how you did that (light laugh).
And then, her therapy actually is in a booklet,
and you are supposed to,
as in most therapies and with most doctors these days,
write down things on a piece of paper
before you go to see the therapist.
Well, now, you can actually
just have a conversation with Marsha.
So on your right,
you can see what the therapy from the left turned into,
by talking to eMarsha on the right.
And, basically, we weren't using machine learning
to do anything really fancy.
We just let the patient write what was going on with them.
We would ask questions, just like Marsha would,
if she was in therapy with you.
You would answer, and then Marsha would say, oh interesting.
So she put a label on it.
So we'd just parrot back what the patient said.
And then, the patient might do a rating
on how they're feeling,
or how bad something is, in the interface,
and then Marsha would respond to that rating.
So, much of it was canned,
but we would parrot back a few things
that the patient said to make it sound personalized.
What we've learned through this exploration
is that conversational user interfaces really work,
and so this is just a look at what happened
over the four weeks with all the patients
that we had in the study.
The hardest to treat,
the borderline personality disorder patients,
actually did improve the least well.
The others, so they're in this curve,
so the curves are actually steeper if we take them out
'cause they're the hardest to treat.
But everyone got better
on these clinically efficacious scales,
which means very well-validated,
well understood by psychologists, scales of improvement.
So we had improvement across the four weeks
for all categories of our patients.
And what we found, and this is my takeaway message,
is that it's empowering to have therapy on a phone,
but it's empowering to have it with you.
So, when you're in your moment of panic or your moment
of doubt, and you're really having bad thoughts,
normally you would have to call a family member,
or a loved one, or your therapist.
And, you might feel that's a burden.
If you can just pull therapy out of your pocket,
go to the skill that you really want to use
in that moment of need,
and see that it actually helped and it worked,
and you feel better, you gain self-efficacy.
And you feel powerful and stronger,
and you believe in this phone app,
and you want to use it again.
And that's what happened with our patients in our study.
So, instead of having to go to their therapist,
they were able to use pocket skills,
which is what we call it, and it worked.
And I wanted to say one last thing, before I finish.
It's that you cannot design, it one size does not fit all.
So, for every kind of intervention,
and you don't need to read the words on this slide,
the point is that, for every kind of intervention
you can design in a therapy app or an app
to help people learn positive coping skills,
there will be some kind of skill that somebody loves,
and another person will hate it.
Some people love playing games
that help them feel better and get less stressed.
Other people hate playing games.
You need to use machine learning to hone in
and personalize the kind of skills
that that person needs to learn in their time of need.
So, you have to as broad and varied a skill set
to help these people as possible, so they don't get bored,
and that they get the skills that actually do help them.
And, with that, I will leave it there.
Okay, thank you.
(applause)
(light pleasant music)