Adjunctive Mobile Technologies for CBT: Part 3Ryan Hansen, M.S.Ohio State UniversityHansen.282@osu.edu

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

IOS Android

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• www.codecademy.com

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 ConfidentialityPsychologists 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?• Email

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?

GamificationZombies, Run!Endomondo

Suicide Prevention Apps

•ASK•Guard Your Buddy•RUOK:OSU

ASKPlatforms iOS, Android

Price Free

Creator Mental Health America of Texas

User Rating 3.5 Stars

Features: National Hotline #Warning SignsHow to AskHotlinesVeteransLGBTQInternet Resources

ASKBest Clean, Efficient Layout

Easy NavigationClear Content

Worst Lack of Telephone Link on Opening PageLots of Text

Research Base No Formal Research

Guard Your BuddyPlatforms iOS, Android

Price Free

Creator Tennessee National Guard, Parthenon Publishing

User Rating 4.5 Stars

Features: Get Help NowWarning SignsHow to HelpDo’s/Don’tsInternet Resources• Veterans• Families• Money• FeelingsRascal Flatts Pledge

Best Professional DesignEasy NavigationConcise Text

Worst Veteran SpecificLimited Info In-AppLinks to website, which does not load in iOS

Research Base No Formal Research

Guard Your Buddy

RUOK:OSUPlatforms iOS, Android, HTML5

Price Free

Creator OSU Suicide Prevention

User Rating Not Rated

Features: Local Crisis Line (Ohio)National Hotline #Campus Police #Warning SignsHow to AskShare the App (QR)Special Populations• LGBTQ• Veterans• Spanish• TTYOSU Resources

Best Uses User’s LocationProvides OSU and National Resources

Worst Text-heavyOSU Specific ContentOnly Ohio Crisis Lines

Research Base No Formal Research

RUOK:OSU

PTSD

•PTSD Coach•PECoach

PTSD CoachPlatforms iOS, Android

Price Free

Creator National Center for PTSD, National Center for Telehealth and Technology.

User Rating 4 Stars

Features: Psychoeducation • PTSD• TherapyAssessment and Symptom TrackingSymptom Management ToolsSupport NetworkProfessional Referral Information

Best Both text and multimediaTools for symptom trackingTools for symptom managementRating distress before and after interventions

Worst Bug in Manage SymptomsAssessment only Tracks Total Score

Research Base

No formal research, uses many techniques from Prolonged Exposure and CBT

PTSD Coach

PECoachPlatforms iOS, Android

Price Free

Creator National Center for PTSD, National Center for Telehealth and Technology.

User Rating 4.5 Stars

Features: Psychoeducation Record Therapy SessionsAppointment RemindersBreathing Retraining Suds AnchorsSymptom Assessment (PCL)Security Settings

Best Both text and multimediaTools for symptom trackingRecording SessionsRecording Exposure ExercisesSecurity Settings

Worst Cant delete recordingsRigid Structure

Research Base

No formal research, Uses techniques from Prolonged Exposure

PECoach

DBT Diary Card and Skills Coach

Platforms iOS only

Price $4.99

Creator Durham DBT inc.

User Rating 4.5 Stars

Features: Diary Card • Skills• Targets• NotesExtensive Coaching Dialogues• 911 Skills• Distress Tolerance• Mindfulness• Emotion• Interpersonal SkillsDBT Reference

Best Professional DesignEasy to NavigateHighly CustomizableUses Apps and Music for DistractionPassword ProtectedEmail Diary Card

Worst Lots of small text

Research Base

No formal research, Designed to be incorporated into DBT treatment

DBT Diary Card and Skills Coach

LiveHappyPlatforms iOS only

Price $0.99

Creator Signal Patterns, Dr. Sonja Lyubomirsky

User Rating 3 Stars

Features: Savoring ActivitiesSocial Activities• Acts of Kindness• Developing Support NetworkStrive (Goal Setting)Gratitude JournalOptimismPsychoeducation on Positive Psychology

Best Professional DesignSimple to useMultimedia

Worst Relatively Few FeaturesComplaints of Bugs/InstabilitySlow streaming with videos

Research Base

No formal research, Uses practices supported by research in Positive Psychology

LiveHappy