Lunch №2: Digital Well-being E-health, and
In this series, I am documenting a string of lunches hosted by bUm, Berlin’s new hub for civic engagement. We started the project as a way to gather people interested in the intersection of digitization and what it means to live a good life. As it evolves, we hope to inspire conversations about how we use technology, while offering some insights from people who work in this field every day.
Appetizers
The relationship between digitization and health, especially mental health, is a topic of wide debate. However, when having this conversation, I often notice that people are quick to jump to dystopian visions for how digital technologies will influence healthcare, especially when it comes to mental health.
In this post, I want to share some insights from the second meeting in a series of lunches meant to explore the relationship between digitization and what it means to live a good life. At our first lunch, we talked about the topic of digital wellbeing more generally, focusing on the omni-presence of tech in our personal as well as professional lives. In this second meeting, hosted at the Google headquarters in Berlin, we wanted to understand how online/mobile apps can provide and complement mental health care, as well as a vision for AI-enabled coaching.
Digital Health: GET.ON
Online therapy has been around for a while, but a completely digital intervention is something much more new. One of our participants, David D. Ebert is the co-founder of a German startup called GET.ON, which provides digital interventions for the treatment/prevention of mental health disorders.
The core idea for the project came from the recognition that very few people access the mental health system, and accordingly don’t receive support in a time when they really need it.
This is due to a myriad of reasons, the two most significant being stigma and cost. Mental health treatment can be expensive, and it doesn’t help that most people don’t want to engage with therapy in the first place. Many wish to deal with their problems on their own.
For this reason, David’s project attempts a human centered approach, acknowledging the various barriers that we face as human beings when we need help. Rather than telling people what is good for them, GET.ON asks us what we want from ourselves and from a therapy. It then seeks to support the individual in finding interventions that help understand/ deal/ manage or overcome an identified disorder.
Why make this service digital though, why not use face-to-face therapy? First, and most obviously, digitizing this process makes it accessible to huge numbers of people, as well as much cheaper. Using a mobile device can also be helpful in creating interventions for people at the right time and in the right place. It provides a degree of consistency and constancy of care that is not possible with traditional therapy.
So far, the results of the 40 clinical trials have indicated that for the sleep insomnia, anxiety, and stress interventions, the app works just as well as gold standard face-to-face therapy.
It is important to note, however, that these clinical trials were conducted on a mostly culturally homogeneous sample. Omosola Odetunde, product and engineering advisor, pointed out that in order to launch in other countries clinical trials would have to be conducted across geographical and cultural boundaries.
Therapeutic Approaches
Can tech deal with complexity of mental health? Joana Breidenbach, anthropologist and social entrepreneur, brought us to this question by asking what kinds of therapeutic approaches are used in digital health apps. Because apps cater to so many people, and must be somewhat standardized, they tend to stick with evidence-based approaches that can be quantified. As cognitive behavioral therapy and mindfulness/ commitment therapy are among the best researched, these are the dominating approaches.
This means that digital services cannot provide (or experiment with) alternative approaches that some might find helpful or enriching. One could wonder, then, if the digital platform limits possibilities that work well but can’t (yet) be quantified scientifically. However, I think this is a nuanced topic, since introducing therapies that are difficult to test with precision could have really bad consequences. Especially since digital therapies have such a wide reach.
When we look back at certain therapeutic approaches from the 20th century, some of which were even considered standard and “evidence-based”, we can see the potential harm psychological intervention can have on large populations. Gay conversion therapy is a particularly good example. It was considered standard among American psychologists until the gay community, as well as a handful of psychologists, suggested that therapists were not treating an abnormal pathology, but rather enforcing a cultural assumption that homosexuality is a defect.
In the future, there might be a way to explore alternative treatments digitally while maintaining quality control, but as David D. commented, everything can’t be done at once.
Wait … what caused what?
In recent years, it seems like mental illness has sky-rocketed. Is there really epidemic and, if so, does digitization play a significant role? We are often inclined to think of our own time as being particularly transformative and radical when compared to the past. However, in our conversation, Nikos Green, a cognitive neuroscientist, offered some interesting perspective on the role of expanding definitions when it comes to mental illness diagnosis.
“When the media claims that there are huge increases each year in the number of people diagnosed with depression, we have to remember that the definition of depression is expanding as well. If we don’t keep this in mind, we begin to think that we live in an unprecedented time where everyone is sadder than they have ever been. We don’t really know if this is true. ”
Max Senges, a digital philosopher at Google, spoke about a reminiscent situation in the early 1900’s when Freud coined the term The Oedipus Complex. All of the sudden everyone seemed to have secret fantasies about their mother or father, introducing a sexual catastrophe that not only threatened familial relations but also basic inhibitions prescribed by time and nature. These fantasies or desires existed before Freud, but by giving them a name they took a new shape in the collective conscious. They became something to fear, to be ashamed of, and perhaps this act in itself engendered new pathologies.
This recollection of Freud’s “gift” to humanity illustrates the idea that an epidemic can be created, or fabricated, by naming something which already exists, but does not have a definite shape. In this way, the panic acknowledges a real problem, but is confused about the origins.
With the advent of the digital era, and an increasing amount of time spent on social media, many feel that digital devices and apps have caused our current epidemic of depression and anxiety. And intuitively, this seems to make sense. The indicators seem so strong, that we often change the relationship from one of correlation to one of causation. This is where the danger lies.
In a recent article published by WIRED, we get a really good example of how this plays out. The author, Robbie Gonzalez, discusses a book by Jean Twenge on the effect of social media in adolescents, with psychologist Andrew Przybylski.
“When Twenge and her colleagues analyzed data from two nationally representative surveys of hundreds of thousands of kids, they calculated that social media exposure could explain 0.36 percent of the covariance for depressive symptoms in girls. But those results didn’t hold for the boys in the data set. What’s more, that 0.36 percent means that 99.64 percent of the group’s depressive symptoms had nothing to do with social media use. Przybylski puts it another way: “I have the data set they used open in front of me, and…based on that same data set, eating potatoes has the exact same negative effect on depression. And the negative impact of listening to music is 13 times larger than the effect of social media.”
This doesn’t mean that social media has no relationship to depression, it just means that we don’t understand it well enough to start a cultural panic. As a society, we would be well advised to reflect on how social media impacts teenagers, but if we focus all our attention on social media, we run the risk of ignoring other potentially important factors. Whats more, when we conflate social media, which is a very specific subset of the digital world, with all things digital, we forget the positive benefits one can find in tech and digital services. For example, the inspiration, the connection, the efficiency, or the world of knowledge that is at our fingertips.
If we focus on digitization as a force which only does harm in the world, we actively contribute to creating that reality. It leaves only negative notions about the role of digital technologies, without inspiration to create a better future, a future that could be enriched by machines and AI. Of course, we haven’t yet reached this shiny new future, and if we want to move in this direction then we must actively design our path forward– hopefully with care, inclusion, and forethought.
If you are interested in this idea I would suggest checking out some speculative design studios like Superflux in London, or designed reality studios run by Anthony Dunne and Fiona Raby in New York.
Meet my new therapist, her name is Alexa.
Looking forward, AI is becoming a more and more integral part of any digital therapy. This addition allows the service to be highly personalized and specific. Interventions that are difficult to treat with a standardized service, like depression, would significantly improve. Of course, many are concerned about the lack of human contact, and though this is a very important point, there are also some interesting benefits to having an AI approach.
Based on his collaborative research with a large team, Max proposed a vision for the role of AI in which our personal AI assistants (think Siri, Alexa, Cortana, etc.) become mediators, as well as advocates for our personal health goals.
“We propose a three-pronged model in which 1) science and 2) {personal health} data are enabling an AI mediator that continually engages in open dialogue with the user in order to define his or her 3) well-being related goals.”
This means that the AI would act as an interface, helping us make better decisions for our overall well-being based on what science finds to be healthy, as well as what we have determined to be our personal health goals. They envision the relationship between the user and the AI to take the form of a health coach which serves to augment the user.
“Whenever appropriate, this personal intelligence will engage in open-ended dialogue in which the AI serves as a portal to the world’s knowledge while knowing the user’s expertise and preferences.”
If done well, and responsibly, this model could significantly help individuals, as well as health care providers, sift through the huge amounts of health related data to access information that is relevant. It is worth mentioning however, that though the potential of AI in the health and well-being sector is very large, many agree that a hybrid human-tech approach is best– at least for now.
What Big Data has to offer
Large-scale research into mental health has always been a relatively difficult task. There are so many variables in face-to-face therapy, for example: it is difficult to standardize, it takes a lot of time, it is expensive, and most importantly, the sample sizes are generally very small. Digital mental health services enable researchers to access hitherto unprecedented amounts of data, and therefore develop much better care. This coming revolution necessitates that we have an already overdue conversation about the benefits of sharing information versus the protection of privacy. This means that we have to consider what privacy means to different people, what is important to us, what do we value?
If you are interested in this last question, look forward to our 4th lunchtime article in which we discuss value based design, and how we might be able to live out our values in a digital world.
Jump to our third lunch on meditation, consciousness, and spirituality.
Thank you to all of our wonderful participants!
- Dr. Joana Breidenbach: Anthropologist, co-founder of Betterplace, Betterplace Lab, and Das Dach, co-author of New Work Needs Inner Work, among other works.
- Dr. David D. Ebert: President at International Society for Research on Internet Interventions (ISRII)
- Nikos Green: Interdisciplinary scientist turned entrepreneur, currently a senior consultant at Roland Berger. All of the thoughts Nikos expressed in this article represent his own ideas and not those of his employer.
- Ben Mason: Project Lead: “Digital Routes to Integration” at the betterplace lab.
- Dr. David Aagten-Murphy: leads the science and product team at neuraltrain, a young startup developing a new type of digital intervention for mood disorders and depression.
- Jennifer Neal: Author, editor, journalist, standup comedian, TV presenter, and editorial manager at Clue.
- Omosola Odetunde: Advisor, CTO, Engineering & Product development for Startups as well as a public speaker on topics related to tech, ethics, and AI.
- Daniel von Waldthausen: Founder of NWTN-BERLIN
As far as necessary, all rights to the images used here have been clarified with the artists or producers. For some images I have paid a small amount of money. For others I made a donation to non-profit projects in agreement with the artists. However, most of the creators agreed that their works are used here free of charge. I’d like to express my gratitude to all of them.
