Posted on April 30, 2016
Bryan Foster & Swatee Surve
Twenty years ago, I was 14. I had an email address. I was required to take keyboarding class in high school, and “dialed up” to AOL. I used Microsoft Encarta to look up information for school. I had a personal webpage on Geocities and I had a pager so my parents could get ahold of me when they didn’t know where I was, which was virtually every day.
Now, I have at least ten email addresses, a virtual keyboard on my iPhone, and always on and fast Internet access. I have endless information at the other end of the Google search bar. I have a business webpage with Internet 2.0 architecture and my iPhone has more computing power, intelligence, and memory than the $3,000 Packard-Bell desktop my family had twenty years ago. And, that iPhone has apps. And games. Something a “phone” never had before.
I’ve been practicing psychotherapy in the Tacoma area for five years and in that span of time, it’s been an adventure keeping up with all the changes. As a Licensed Marriage and Family Therapist, I am used to thinking of the larger systems that are influencing my clients. Such as their relationships, family systems, culture, and community. I also like to spend time thinking about and studying the systems that are influencing therapy itself and the technology sector is having a big impact.
Technology is amazing and apps have ushered in a new era of therapeutic engagement that has the potential to completely overhaul the therapy experience.
I want to tell you about a few of the apps I use to help clients maximize their therapy experience and I’m going to tell you what I think is around the corner.
There is a wealth of wonderful apps related to psychotherapy. There are also a lot of duds. I’m mentioning the three that I find to be the most useful. They are all free! They were also all developed by the Veterans Administration for Servicemembers and Veterans but I think they can benefit all clients.
1. PTSD Coach – an adjunctive “self-help” app filled with psychoeducation, assessment, and symptom reduction tools designed to help clients with symptoms of Posttraumatic Stress.
2. Tactical Breathing – a helpful introduction to emotion modulation for all ages.
3. Mindfulness Coach – as mindfulness and meditation become evidence-based strategies, apps such as Mindfulness Coach are important to help train your clients and allow them practice outside of the session.
I have found these three apps to be the most useful for my clients. Clients are able to practice the skills and concepts that I teach them in session and when my clients use these apps, their progress is often quicker and longer lasting.
But as useful as they apps are, what is coming next is the “game” changer. There is one issue with these apps. There isn’t any additional motivation to keep using them besides therapist suggestion and client willingness. What’s coming next…is games. You may have seen the April 26, 2015 WSJ Cover Story: The Future of Games Will Focus on Escaping From Reality—and Improving It where Jane McGonigal predicts “games that treat mental-health issues" are one of four life-changing games that will be "extremely popular in the next decade.....Doctors and therapists could prescribe casual video games ….. as a first line of attack against depression, anxiety and post-traumatic stress disorder."
For over the past year, I have been fortunate to be a part of beta testing a game called Sinasprite, developed by Litesprite, a Washington-based company, which is bridging the gap between apps and games. You may have seen them featured on NPR KUOW Morning edition or on NBC King 5's Tech Talk. They have also received financial and in-kind awards by the U.S. Army, Robert Wood Johnson Foundation, SXSW, Livestrong Foundation, and Singularity University. Their active pilot with the U.S. Army’s Madigan Army Medical Center, primary care clinics, and public beta, are showing improvements in coping skills, depression and anxiety symptoms.
The initial game, Sinasprite, uses not just one, but a variety of evidence-based treatment methods, including CBT-based strategies (ie. visualization, journaling, diaphragmatic breathing) and meditation, to help people manage stress, anxiety, and depression. In Sinasprite, users “unlock” new strategies, experiences, and rewards as they explore the Sinasprite environment and as they “play” the skills. These activities are set in a pleasant, adventurous world where Socks the Fox guides and encourages the user. For example, if you do journaling through Sinasprite, you’ll unlock new things to do such as a virtual fishing game. Players are encouraged to go for a walk in the Augmented Reality Butterfly stroll. All of these activities have a therapeutic component. Some help users learn and practice meditation and mindfulness. The Oracle module provides psychoeducation and assessment and there is a journal that users can use to articulate their worries and receive help in letting go of or dealing with those fears.
This platform provides players (clients) with the added motivation to continue to play and practice useful therapy-enhancing strategies. It keeps users engaged and interested in playing it, helping to create a meaningful behavioral change. And that is because player activity and content is collected inside the game and can be reviewed by clinicians and players to see the change that is happening.
My clients, who have used Sinasprite, seem appear to achieve lower scores on depression and anxiety assessments more quickly and they report more application and retention of concepts we work on together in session. Now, for the first time, customized strategies and approaches can be developed. Future developments include the ability for clinicians to send assessments or messages to an individual or group of players. Another is an in-game experience to develop gratitude.
One of the most frequent complaints I receive from clients about the apps I suggest they use to boost their psychological well-being is that the apps are boring. The future looks bright for these clients. Sinasprite, and gaming, is about to knock their “Socks” off.
Sample Player Feedback includes:
“A little therapeutic sherpa.”
“ For some reason it taught me to enjoy relaxing or having fun more.”
“I miss Socks, please help! ;)"
“This doesn't make me feel like I have a mental health problem.”
The company is looking to expand their current base. Providers are selecting either of these options:
1. Free access to a 6-week program for your patients via the public beta. They currently have 6 referring clinicians in our beta, and more signing up weekly. If your clients can benefit from this tool, please send them directly to litesprite.com to sign up.
2. Become an early adopter customer. Lock in pre-commercial pricing and review real-time data of your clients which you can use to improve care, submit for Meaningful Use Quality Metrics, and other data to fulfill performance/ accreditation requirements.
If you would find it helpful, please email email@example.com. They would be happy to do a 15-minute orientation session to review the player experience and the type of data that is available.
Either option allows your to offer your patients tools that support improvements in anxiety symptoms, depression symptoms, and coping skills. And we’d love to explore other possibilities to work with you.
For participation, testers get:
1. Free access to a 6 week program that teaches proven stress management techniques.
2. Free access to an on-demand self-help tool.
3. Progress report at the end of the study.
Minimum requirements for testers:
1. Age 18 years or older.
3. In possession of a personal phone or tablet for use during the study. Note we don't yet support the Nook.
4. iPhone / iPad users must be running at least iOS 8.
• A 15 min pre-screening questionnaire.
• 6 week app pilot study.
• A 10 min questionnaire post 6 week study.
• A 10 min questionnaire post 12 week study.
Below is some additional information about the company:
• A VentureBeat piece.
About Bryan Foster
Bryan is a Licensed Marriage and Family Therapist. He has been practicing psychotherapy for over ten years. Bryan practices primarily evidence-based treatment modalities, rooted in Cognitive-Behavioral Therapy, which research shows is an effective treatment for many common mental health or emotional issues. Bryan has helped hundreds of individuals and families improve their communication, reduce or eliminate symptoms of anxiety, depression, PTSD, and manage ADHD, anger, and many other symptoms of emotional or mental health conditions. Bryan specializes in couples/marriage therapy and has helped couples recover from affairs, improve their communication, prepare for the next step in their relationship, and learn innovative skills to be effective parents.
About Swatee Surve
Swatee is the Founder & CEO of Litesprite. A leader who has developed and launched disruptive technology-based healthcare businesses for Microsoft, Nike, T-Mobile, Premera Blue Cross and Eastman Kodak. These efforts led to several commercialization efforts and patents, some of which were in biofeedback and Nike's first wearable technology patents. As a Lead Consultant at Premera Blue Cross she led executive teams to identify new opportunities in wellness and member engagement programs. At T-Mobile, Swatee incubated and launched the V1.0 Android Bobsled Group Messaging application and created the firm's mobile health strategy. At Microsoft Research she fostered collaborations in medical imaging. Swatee has an MBA from the University of Chicago, an MSME and Biomechanics from Pennsylvania State, and a BS in Bioengineering from the University of Illinois at Chicago.