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

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.

 

Health service psychologists wanted! How do we get there?

Thanks to the Affordable Care Act (ACA), there is a greater need than ever for psychologists in integrated health care. But what is integrated health care? A comprehensive definition from APA is here, but basically it reflects the growing interdisciplinary nature of the health-care system and recognizes the need to develop  comprehensive treatment — and prevention — plans to meet patients’ psychological, social and medical needs.

Many psychologists are interested in working collaboratively in a medical setting, but how do we ensure that psychologists are ready upon graduation?

A symposium panel, chaired by Dr. Emil Rodolfa, answered that question by discussing several important areas. The first was competencies. Dr. Stephanie Wood of Alliant International University outlined the competencies health service psychologists need. These include:

  • Interprofessionalism: The ability to work collaboratively with others in a medical team, including speaking the same language (e.g., what is a electronic medical record?)
  • Leadership: Positioning psychologists to be in an ideal situation to lead effectively in medical settings. This includes not being afraid to ask physicians questions and working to ensure psychology remains an integral part of integrated care teams.
  • Cultural competence: Raising the level of knowledge around who seeks care and why.
  • Use of evidence-based interventions: Teaching psychologists to effectively review the literature and implement only interventions that have a robust evidence base.

The good news is that there are already programs in place for this sort of health services training, particularly at the clinical internship level.

Dr. Jeffrey Baker, the executive director of APPIC, reported there are 226 internship programs that provide experiences in integrated primary health care. Others provide more specialized training. Also, there are as many as 63 APPIC postdoctoral programs that offer ample experience. Check out the APPIC website for more details.

The medical system is changing and there is a true need for trained psychologists that can navigate health care and deliver psychological treatments to those in need.

Is Allison More Likely than Lakisha To Receive an Offer for Mental Health Treatment?

The subtle effects of racism and implicit bias are pervasive. Researchers have long known that people with African-American sounding names are at a disadvantage when applying for jobs. Now, research presented in a poster session at the 2015 APA convention suggests that they may also face discrimination when trying to access mental health services.

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In a well-known 2003 study, two economists sent more than 5,000 identical resumes to companies in Chicago and Boston. The only difference was that some of the resumes had stereotypically white names on top (Emily and Greg) and some had stereotypically African-American names (Lakisha and Jamal). The researchers found that “Emily” and “Greg” received 50 percent more callbacks than “Lakisha” and “Jamal.”

Psychologist Richard Q. Shin, PhD, of the University of Maryland, wondered whether that effect would translate to the mental health area.

Together with graduate students Jamie Welch and Ijeoma Ezeofor, and colleagues at the University of Vermont, he left voicemail messages for 371 Maryland mental health provicers. The messages — recorded by the same woman, using the same wording — purported to be from a prospective client named either Lakisha or Allison, looking for counseling services.

The researchers found that “Lakisha” and “Allison” received calls back from the mental health providers at the same rate. However, “Allison” was significantly more likely (12 percent) to receive an offer of services (as opposed, for example, to being told that the provider wasn’t accepting new clients).

Welch says that psychologists, counselors and others need to be aware of their own implicit biases.

“It’s easy for us to think we’re above the implicit biases that are pervasive in our society,” he says. “But we’re part of that society.”

In future studies, the researchers want to find out whether “Lakisha” faces more discrimination when her voicemail message uses African-American vernacular language. They also want to conduct a larger study with more geographic diversity, and to explore the effects of names from other ethnic backgrounds.

Huge Step for Transgender, Gender Nonconforming People

What is the point of research if  not to make the world a better place? APA has taken this to heart with its approval this week of practice guidelines for psychologists working with transgender and gender nonconforming people. The members of the working group that developed the guidelines described their work at a symposium they called a celebration.

Dr. lore dickey, an assistant professor at Louisiana Tech, said the guidelines may save lives, and called the final product a “labor of love.” The process of developing the guidelines included long working nights and crowded conference calls. The group aimed for accessible language and succeeded, he said.

So what are the guidelines? The entire document can be found here. There are 16 guidelines in total – and I have taken the liberty of listing the first five below, just to provide a flavor.

  1. Psychologists understand that gender is a non-binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.
  1. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.
  1. Psychologists seek to understand how gender identity intersects with other cultural identities of transgender and gender non-conforming (TGNC) people.
  1. Psychologists are aware of how their attitudes and knowledge of gender identity and gender expression may affect the quality of care they provide to TGNC people and their families.
  1. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well-being of TGNC people.