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Gaming, Wearables and Big Data: Psychology’s Hi-Tech Future

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Simulated therapy training. Apps that monitor behavior and stand-in therapy. Vast streams of data shaped into undeniable patterns. According to a report by psychologists on the cutting edge of technology development, these could be familiar practice adds in the not-distant future.

Jason Satterfield, PhD, director of behavioral medicine UCSF Medical Center spoke of how hi-tech training could help equip clinicians to help meet the demands of truly integrated behavioral health care, otherwise known as the patient-centered medical home.

“The average primary care physician has a panel of 2,500 patients … [and] would need to work 21.7 hours per day just to do [treatments], and 7.4 hours per day for prevention, to deliver best standards of care,” he said. Meanwhile, 70 percent of of health care expenditures are due to chronic illness, and one in four of those patients will have diagnosable mental illness.

Newer tools may help clinicians to treat more people more efficiently and effectively. These include social networking using podcasts and online discussion panels, MOOCs (massive open online courses), and e-mentoring and supervision. “Smart care” tools might remind clinicians when it’s time to do a test or when a patient’s record indicates an intervention. Actors could play patients in simulated online scenarios.

To further help access, “extender and augmenter” apps can that help boost the lessons of cognitive behavioral therapy between sessions. For example, one mobile phone app called Addiction CHESS, currently in development, helps people in recovery for substance abuse, buzzing if they’re approaching a behavioral trigger and delivering appropriate messages. There’s also a “panic button” to call for help and therapists after hours.

That said, “There are lots of studies on digital health and ehealth tools, but if you build it, it doesn’t mean people will use it. Folks are too overwhelmed; there are too many choices and too many things to do. As psychologists we need to think about motivation,” Satterfield said.

One way may be through gamification of virtual therapy. People get drawn into games because they’re tapping into the psychology of motivation and rewards, like badges and scores, limiting play time and setting challenges just above your level of ability to add just enough fun.

“What if we had our training programs set up that way? Not to make light of them, but if they were fun and easy to use, and  where people were bored and could take out a pad and do their CBT exercises — how awesome would that be?” he said.

Assessment is critical to helping clinicians and supervisors of care managers make decisions, but can take up much of the time they have with patients, said Patricia Areán, PhD, of the University of Washington.

“We don’t know how our patient is doing until they walk into our office, and [sometimes] don’t even see patients once a week. We also have to rely on self report, which is guided by how person feels that day,” she said. “What if we could capture all of this information before you see your patient? Data collected in real time and presented in a really efficient way gives us the time to do treatments we need to do to make our patients feel better.”

Mobile phones and wearables may be the vehicles. Smartphone apps can give clinicians clues as to how patients are faring by collecting activity and social data, listening for voice data and changes, looking for typing errors and giving quick mood surveys or memory tests, and being on the lookout for texts and emails that get no response. Plus, they could help reach groups that currently lack access; minorities use mobile health apps more than Caucasians, according to Pew surveys, she said. Wearable sensors have grown 110 percent since 2011, and older adults are more likely to use these devices than any other demographic.

“It’s a combination of data points that will really come up with a signal for people on whether they are really doing better or worse,” Areán said.

All of this personal and public health data and electronic health records are generating enormous amounts of useful information, said Kari Stephens, PhD, who teaches biomedical informatics at the University of Washington, but the challenge lies in ” getting this data wrangled and unburying ourselves,” she said.

Government and other groups are spending millions of dollars to create information-sharing networks that have great value for behavioral scientists, she said, including the National Institutes of Health BD2K (big-data-to-knowledge) project,  the Patient-Centered Outcomes Research Institute’s clinical data repository network, the research-focused NIH Collaboratory, and the FDA’s Mini-Sentinel, which monitors the safety of medical products.

“Big data is correlational, not causal. … and messy and that’s OK, as long it’s mediated by human interpretation,” she said. “Lots of reporting pieces can help us figure out how behavioral health specialists are supporting evidence-based care. Imaging mapping a patient to providers to see how well each provider consults across a team. We also need to be thinking out of the box when we pioneer new ways to do research” with data.

Other big data boons on the horizon: cloud services, actigraphy, consumer data clouds, genomic profiling, and discovering new neurocognitive measures. Psychologists are integral to designing and implementing these tools, and supervising real world change in practice and policy, she said.

 

Cyberbullying: R U 4 real ????

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When kids communicate online, their relationships in real life may help them determine whether someone is cyberbullying.

Emoticons, writing in all caps and using acronyms can influence adolescents’ perceptions of what their peers write, helping replace other cues like tone of voice and facial expressions that might help them interpret meaning in real life. Still, an offline relationship guides how kids might interpret ambiguous sentences such as, “I’ll find you after school. :-) ”

Michal Bak, a graduate student at the University of Victoria, British Columbia, presented a pilot study on how young people process information online during a symposium entitled “Cyber Aggression – Perceptions, Behaviors and Influential Factors.” While knowing a writer helps, research in the field so far suggests that other things come into play, such as social status, when kids react to what’s put online, he said.

“Social status cues may be more prominent in online settings, because adolescents can obtain additional info like followers, positive comments, likes and up-votes,” Bak said. The 30 youngsters he and his team interviewed often couldn’t recall receiving ambiguous messages, but “sometimes emoticons tend to obscure the message, and we find that students tend to hide their real intentions using them,” he said.

More people may be liable to come to a victim’s defense in real life, too, according to work from Nicole Summers, a graduate student at Carleton University. She and her research colleagues are studying moral disengagement in cyber aggression.

Looking at almost 500 emerging adults in Canada ages 16 to 20, she and her colleagues found that over 88 percent of them reported having read insults or mean comments in social media forums at least once in the past year, and over 35 percent of participants witnessed these behaviors weekly. Those who had higher levels of moral disengagement – such as believing one couldn’t help, blaming or dehumanizing the bullying victim, or disregarding help – were more likely to have pro-bullying behaviors such as enjoying reading mean online posts.

“In [real life] social situations you can be an insider, meaning somebody who goes along with bullying, but being online you’re always an outsider. You don’t have to disengage online, because you’re already disengaged to begin with,” she said.

When it comes to online versus social aggression, gender may make a difference, said Megan Lamb, a graduate student at Carleton University. In her study of 429 students ages 11 to 18 in rural eastern Canada, 86 percent reported using social aggression against a friend, and 92 percent reported being socially victimized by a friend in the past school year. The bullying happened online, too, and there was a strong relationship to bullying or being victimized in both arenas. About half of all students reported using cyber aggression against a friend in the past school year, and 67 percent reported being victimized.

Girls reported using and being victims of face-to-face social aggression more than boys. However, boys and girls did not differ much in how often they engaged in cyber aggression.

“Boys are often less comfortable using social aggression, but because cyber aggression is more anonymous, maybe [they] feel more comfortable using that,” she said.

How mindfulness can help psychologists and their patients

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With its emphasis on acceptance, continual exploration and compassion, the practice of mindfulness makes sense as a tool for clinical psychologists and their patients, said author and meditation teacher Sharon Salzberg. She spoke before some 200 psychologists in a conversation with Donna Rockwell, PsyD, a clinical psychologist who is also a meditation teacher.

By training the mind to focus on the present and accept thoughts without judging or dwelling on them, mindfulness can help patients who ruminate over past events, catastrophize or worry about the future, Salzberg said.

“It’s a quality of awareness where our attention is not distorted by bias or fears of the future or physical discomfort,” she said. “By relinquishing the hold of some of these add-ons, the belief is we have a chance of a cleaner, clearer experience of what’s happening right now.”

That calm contemplation may lead to greater insight into how our emotions come to be, and a better chance at managing them, Salzberg said. “It’s the understanding which comes from the equanimity — knowing there’s something going on, but not immediately reacting and jumping in so we have space to look more deeply,” she said.

Mindfulness skills might help psychologists with their own stress, too, Salzberg said.

“Mindfulness might help the clinician who is really dealing hour after hour and day after day with some really difficult material that others are presenting,” she said. “It’s independent of a belief system and equipment, and it’s an experiment in itself. If you practice every day for 10 minutes and you’re then at work and there’s a crazy situation … you can be breathing and it’s there for you.”

Women’s Life Problems Aren’t Always Medical Problems

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Medicine and the media are helping to medicalize everyday life experiences like anxiety, sadness, weight loss, menopause, and reproductive health, and women are the primary targets, according to psychologists and co-authors of a new book, “The Wrong Prescription for Women,” who spoke at a symposium on the topic.

While it’s important to acknowledge and treat real illness, women are too often prescribed medicines and medical procedures, more so than men, even when their experiences are normal.  “Many of these treatments aren’t problematic,  but the problem is they make normal parts of our lifes and bodies and experiences [seem abnormal]. The pharmaceutical industry created [these issues] to sell drugs to everyone, and sadly they’ve been very effective at this,” said Maureen McHugh, PhD, of Indiana University of Pennsylvania.

For example, modern society has a tendency to look at the prolonged grief that may naturally accompany a loss as depression that needs medication. Women are more likely to express their grief more explicitly and intensely, said Leeat Granek, PhD, Ben-Gurion University of the Negev.

“Women [have long been] expected to carry grief for their families and communities and states. Today, women are being pathologized for doing this job too well,” Granek said. Society — and clinicians — see grieving as a much briefer process with a deadline for moving on, which can be as little as two weeks, she said.

Woman taking medicines

Women are far more likely than men to be diagnosed with depression and to be prescribed medications for it, which can be a broad form of social control, said Alisha Ali, PhD, of New York University. “If you’re a deviant outside the norm, we are believed to have the responsibility of ‘fixing you’ so we can bring you inside of the norm,” she said.

However, women most prone to depression are also the most marginalized, including those who are abused, poor or victimized. When they take medication for depression, women report reduction in self-destructive thoughts, but also report apathy and disengagement, Ali said.

“Therefore, treatment for depression chemically neutralizes the very feelings most needed to fight for social change. We need approaches to depression that can support women in changing the material conditions of their lives. We need empirical research documenting the effectiveness of feminist-informed approaches to treating depression and other mental health problems,” she said.

Even menstruation is becoming taboo, said Jessica Barnack-Tavlaris, PhD, of The College of New Jersey. Perhaps influenced by advertisements that promote convenience, women are increasingly using contraceptives to suppress menstruation, and doctors giving them to young women to counter the effects of early puberty.

“Viewing menstruation as negative, not normal, or unnecessary has implications for women’s physical and emotional well-being. Some women will then experience shame with menstruation and those who do that are more likely to self-objectify,” she said.

Mindy Erchull, PhD, associate professor at the University of Mary Washington, spoke of how media promote an unnaturally thin body, with the result that it has become the norm for women to be dissatisfied with their bodies.

The thin ideal now often encompasses a fit ideal, especially in advertisements, Urchell said – a dual standard that may be even harder to achieve, as “Most people assume that to be fit you have to be thin. But muscles take up room,” she said. At the same time, breasts are seen as desirable, yet they mainly consist of body fat.

Even public health officials may cause undue worrying with the so-called war on obesity that primarily targets women, said Christine Smith, PhD, of the University of Wisconsin-Green Bay. Women are more likely to be labeled obese and more likely to turn to bariatric surgery – now offered to women who are as little as 20 pounds overweight — which can have serious side effects, such as digestive problems and nutritional deficiencies. Yet the link between weight and health isn’t definitive, she said: “The war on obesity is common trope … that we need to have people lose weight, otherwise our health system is going to collapse.”

Worrying about your body can limit women’ lives on multiple levels, including “how we think of our bodies, of ourselves and how we think of other women,” McHugh said. “When you feel your or your body isn’t good enough, it makes it hard to become socially engaged. And worrying about our thighs takes attention away from other activities.”

Mom’s Attitude Can Affect Dad’s Parenting

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To get fathers to be more involved with their children, mothers should encourage dads to play a bigger role in their children’s upbringing — and then remember to step back and let them do just that, according to presenters Thursday at a symposium on fathers’ parenting patterns during the 2015 APA Annual Convention in Toronto.

Instead, some 21 percent of mothers engage in what’s known as “maternal gatekeeping,” where they might consciously or unconsciously dissuade fathers from helping with child-related chores or activities, or just do the tasks themselves, said Alex Rowell, a doctoral student at Ohio University, who presented at the symposium, “A Quantitative Evaluation of New Fatherhood: Implications for Policy and Practice.” That’s partly because of society’s expectations, standards and social validation of child-rearing duties, he said. And it can lead to dads taking a lesser role in parenting.

parenting“[Maternal gatekeeping] affects paternal abilities, as in how confident fathers are in being able to do tasks like changing diapers or arranging playdates,” Rowell said. “There’s not that reinforcement of confidence, so [he might] start withdrawing a little bit.” Other barriers may include gender role conflict, professional biases and work-life balance, anxiety and feelings of low self-efficacy when it comes to parenting.

Still,  dads have a greater role in parenting than is often thought, and their interaction with their children can have a big influence on how those children develop. According to what’s called the activation relationship theory, fathers interact with children differently than do mothers. They can help their children learn how to safely explore the world, and they bring a playful attitude to parenting that helps kids learn about appropriate social behavior.

“The central nervous system is spiked a little more through rough-and-tumble play, and the child has to learn to self-regulate,” Rowell said. Other studies suggest that a father’s involvement at various ages can protect against negative psychological conditions and influence a child’s motor development, school readiness and IQ.

Psychologists still are trying to tease out how family, mental health and social factors come into play for new fathers and to develop measures for their involvement, said Brian Cole, PhD, an assistant professor at Seton Hall University.

“Parenting doesn’t occur in a vacuum, and there’s no manual,” Cole said. “When you pair that with gender norms that discourage men from taking an active role in parenting, it’s important to understand what processes encourage men to actively engage in it.” Research so far suggests that social support is a significant factor.

Researchers in the field also are studying how these relationships play out with single- or same-sex parents.