The digital age has left nothing untouched, least of all mental health.
Technology has provided new methods for studying and treating mental illness and has perhaps even redefined the field of psychology.
The Columbia University research community is taking full advantage of these methods. Recently, Barnard’s Affect and Relationships Lab has conducted several “diary studies” using Personal Digital Assistants (PDAs) to track subjects’ changes in mood.
One such diary project is the Barnard/Columbia Personality Study, which examines cognitive and affective processing of individuals with Borderline Personality Disorder and Avoidant Personality Disorder. Participants in this study are given PDAs, which randomly alert them to fill out a questionnaire about their moods and thoughts five times a day for three weeks. According to Landon Fuhrman, the project coordinator, these devices have been key in collecting data.
“The advantage of this is being able to gather information about people in their daily lives that you can’t really gather in the lab,” Fuhrman said. “It’s more ecologically valid in the sense that you’re getting information from these people in their daily lives, with everything that they encounter. It’s an interesting way of collecting data if you’re interested in how things change in their daily life. ”
While paper and pencil diaries have been used in the past, electronic diaries are often more reliable.
“One of the problems with paper and pencil diaries is that you can’t really guarantee that people are filling these out at the times they have agreed to fill them out,” Fuhrman said. “There’s no way for you to prevent them from filling them out all at the very last minute before they come back into the lab. One of the benefits of the electronic diary is that all the entries are time stamped. When it comes back into the lab, it’s a very simple process of uploading the data into a computer. A human is not entering the data and so there’s less opportunity for error.”
However, the convenience of the device for the study can depend on how convenient it is for its users. Some of the 90 participants in the study have had difficulty adjusting to the technology, and, as a result, they do not always enter their responses when they are alerted.
“We’ve had people as old as 70 who have never seen a palm pilot, never had a cell phone, and just need a little more training in the beginning,” Fuhrman said.
Technology has also played an important role in finding a wide range of subjects. Fuhrman has advertised the study on many mental health Web sites such as the National Alliance on Mental Illness, Mood Disorders Support Group, and Anxiety Disorders Association of America as well as on Facebook. Online outreach has helped contact certain populations that may be difficult to reach otherwise.
“One of the groups we are studying are people with Avoidant Personality Disorder ... These people are incredibly fearful of rejection and very inhibited in social situations,” Fuhrman said. “Contact via the Internet, I think, is in some ways less threatening because they are not being faced with the same potential for rejection that they’re always feeling in their daily life when they are engaging in social interactions.”
The comfort zone of the Internet may help other reluctant patients to become more active participants as well.
“I think there’s a lot of stigma surrounding being given diagnoses, certain diagnoses in particular, that individuals feel shameful about,” Fuhrman said. “I think reaching out via the Internet, which is more anonymous, can be really beneficial.”
Online outreach is not only being utilized in the study of mental illness, but also its treatment. Online therapy sites have appeared all over the Internet in the past few years, all based on a policy of safe yet open disclosure. PatientsLikeMe.com, which houses a mood disorders site as well as sites for other medical illnesses, touts an open philosophy along with its standard privacy policy. According to this philosophy, sharing information is enormously useful for patients everywhere.
“When patients share real-world data, collaboration on a global scale becomes possible,” the philosophy states on the PatientsLikeMe site.
In stark contrast with the traditionally private experience of mental illness, PatientsLikeMe seeks to open up discussion among patients and add to their “collective knowledge.” After members join, they can use the site’s tools to add information and reviews about specific medications and therapies. There’s also a mood tracker, which shows how a person’s emotional states develop over time. Members give advice and support on the forums.
“We believe the Internet can democratize patient data and accelerate research like never before,” the site claims. “Furthermore, we believe data belongs to you the patient to share with other patients, caregivers, physicians, researchers, pharmaceutical and medical device companies, and anyone else that can help make patients’ lives better.”
Fuhrman, too, has noticed possible therapeutic elements in sharing information while collecting data for the Personality Study.
“One thing that has become apparent to me running this study over the last year, when these people bring these devices into the lab, some of them have a fantastic experience with it, and they don’t want to give it up,” she said. “I think there’s something therapeutic about the simple act of taking the time to sit down, think about and record your moods, your thoughts at a certain time.”
This unintentional result may be relevant to private therapy practices. Fuhrman theorized the possible use of PDAs or other diary devices in traditional psychotherapy.
“I could see diary methods being in adjunct to traditional therapy. A lot of times these people are going in once a week, or even less frequently,” Fuhrman said. “I think it could be an important adjunctive treatment to have these people take these devices home during the week and bringing them back to their therapist the following week and being able to track what has happened during this week, how is my mood affected, and what were the factors that influenced my mood? What was going on that made a big impact between then and now?”