1. Engagement with Mobile Technology in Research & Treatment MATTHEW PRICE CENTER FOR RESEARCH ON EMOTION, STRESS, AND TECHNOLOGY UNIVERSITY OF VERMONT @DR_MATT_P

2. Outline  Overview of what phones can do and what we do with them  Empirical and rational evaluation of app use in general  The “One Thing” Strategy as a means to integrate apps into treatment and research  Ways to expand beyond “One Thing”  Strategies to sustain use  What do we do after treatment/protocol ends?

3. Disclosure  The following presentation is based on:  Empirical Evidence  Anecdotal Evidence  Clinical Experience  Personal Experience

4. What can phones do?  Communication  Phone call  SMS  Reminder  Calendar  Scheduling  In the moment information  Internet access  Location based sensors  Entertainment  Bio feedback  Healthkit

5. Smartphones Are Used Frequently! IDC Research, 2013

6. But What Is Used?

7. I lied… most check the weather

8. New Apps Are Rarely Downloaded Comscore, 2014

9. New Apps Rarely Make It Into Rotation

10. Most People Spend Heavily Use 1-2 Apps

11. What Apps Do People Look For?

12. “It’s hard out there for an app” -GARY BENNETT

13. What leads people to use technology-based treatments?

14. Time – “How long will it take?” Usability – “How hard is it to do?” Relevance – “Why am I doing this?” THREE KEY POINTS

15. The Unrealistic Expectation of Apps

16. The Best Advice I Ever Received When Planning My Wedding Was…

17. You Get One Thing

18. Connecting to Help After Trauma (CHAT)  Mobile phone based assessment protocol  Daily assessments of symptoms of recovery  Monitoring of symptoms can facilitate the recovery process  Lower cost and broad reach (90% cell phone ownership)  Aims:  Better understand process of recovery  Evaluate use of SMS protocol  Determine the ease with which providers can Rx

19. Response Rates

20. Responsiveness to SMS Approach  61.1% found them helpful to very helpful  77.8% felt that 15 days of texts was sufficient  16.7% wanted more than 15 days  72.2% felt 1 per day was good, but 27.8% wanted them every other day  Those that wanted daily messages had higher PTSD, Depression, and Disability at follow up assessments

21. Participants’ Thoughts About SMS  “My family didn’t want to talk about it… I felt like I had someone to talk to about the experience with the texts.”  “Someone cared, was concerned, and worried about me… You were concerned about my recovery.”  “I knew that every day at 7(:00PM) someone was there to talk to me. It felt that someone everyday really cared about me...”

22. Provider Burden During Messages Activity Time Per Patient/Per Month Text review of patient text content2-7 minutes 1-month follow up interview (diagnostic interview, assessment of functioning, referral ) 27.5 minutes Follow-up calls that did not yield a response2 minutes Total Time Spent31.5 - 36.5

23. Examples of One Thing Apps

24. One Thing for Clinical Care  Record session feature  Easy way to record sessions  Easy to locate place to play back session  Recording does not get sent to iTunes when connected  Able to check if recording was played back

25. One Thing for Research

26. Ways to Get More Than 1 Thing Use Sensors

27. Or Be On Facebook

28. After you have successfully implemented your 1 thing, you can add…

29. How Do We Sustain Engagement?

30. Supportive Accountability Model

31. Apps should be adjuncts to treatment… “I would not use this app if it meant I would have less time with my doctor.” -Usability Participant

32. Provide Feedback “Share data, not give data”

33. A note on feedback People like thisBut they do not like this

34. Game-ify the Treatment Experience “How do we make getting over PTSD fun?” -Joe Ruzek, National Center for PTSD

35. Sustained Use After Treatment  What should we do about a desire to sustained use?  Should we cut participants/patients off at a specified time?  Where will data go?  Will/should therapist still have access to the data?

36. Thank You For Your Time! MATTHEW.PRICE@UVM.EDU @DR_MATT_P HTTP://WWW.UVM.EDU/~CREST/ CENTER FOR RESEARCH ON EMOTION, STRESS, AND TECHNOLOGY