President-elect's column

Headlines such as CNN Health’s article, “Smartphone apps become ‘surrogate therapists,’” lead us to wonder where mobile technology may take us in the future. In recent years, there has been a surge in technology-assisted methods designed to help us monitor and change behavior(s) — via smartphone apps and recording capabilities, and through webbased monitoring techniques. The intersecting of psychological science with technology appears promising in enhancing our ability to initiate, monitor and maintain behavioral, cognitive and mood changes. However, to date, most apps lack the support of efficacy research. We must also recognize limitations that often accompany technological advance(s) and take appropriate precautions with respect to privacy and security issues.

Relevance of self-monitoring

Self-monitoring is particularly important because it holds potential for helping people to change behavior. Psychological research in the late 1960s through the 1970s showed that self-monitoring, through written or oral recordings, helps facilitate this change. Roy Baumeister, in his 2011 book Willpower, reviews how frequent selfmonitoring can improve self-control and discusses studies to support this. In line with his research, recent 32-year-long longitudinal studies by Moffitt et al. (2011) show that those with higher selfcontrol during childhood predict better adult outcomes on health, financial status, and social and interpersonal relationships.

From a mental health perspective, self-monitoring offers an important vehicle for tracking behaviors, thoughts and moods. In this way, patterns may be uncovered and appropriate treatment avenues explored and implemented.

Technology to facilitate self-monitoring

With electronic devices now as close as your pocket, paper-and-pencil methods of recording are no longer the sole way to engage in self-monitoring. Over 500 apps are available to help individuals track their behaviors, thoughts, moods and medical-related symptoms. Self-monitoring components are central to those apps that are designed to target specific mental health issues — from mood and anxiety disorders to substance-related and eating disorders. These apps may augment the therapeutic process by encouraging clients to undertake betweensession assignments by electronically prompting people to engage in self-monitoring behaviors throughout the day and by providing a portable mode of recording. In addition, many of these apps can provide summaries and graphs of the data entered, enabling psychologists to discern, at a glance, a snapshot of the clients’ functioning since the previous session; this mode of communication may also support indirect disclosure. For people not currently working with a psychologist, some of the apps may point users to relevant resources, information, or treatment services.

Tim Steenbergh, a psychology professor at Indiana Wesleyan University who, along with his research lab colleagues, has developed an app to measure ecological momentary assessment (EMA), in other words, collecting data real-time. This website discusses research methodology to support assessment via handheld technology and how it may be harnessed to promote positive behavioral change.

While some of these more comprehensive apps may improve the dissemination of helpful treatment techniques to individuals who might not otherwise receive services, the limitations and precautions listed below should be taken into consideration.

Limitations and precautions

In this day and age, it is relatively easy for “anyone” who is technologically savvy to create an app. Currently, there seems to be no regulatory board that oversees the dissemination of these apps to the public. Unfortunately, some apps may contain viruses or may phish for information. Accordingly, we must draw people’s attention to these risks and direct them toward those apps that have been designed in collaboration with specialists in the field and, to the extent possible, which are based on empirical research. Also important to consider are limitations involving privacy concerns. On some phones, the data are backed up to a virtual storage space. However, at the present time, it is unclear how “protected” these networked online storage systems actually are. Conversely, individuals with mobile devices that do not routinely back up their data may run the risk of losing all of their data (e.g., if the device is lost) or of having their data compromised in the event that appropriate security features have not been implemented.

Also, there are concerns associated with apps created to alert professionals or caretakers that are based on communication and movement patterns, or on clients’ reports of serious symptoms (e.g., suicidal thoughts). Mistakes or misuses of these applications may lead to potential liability issues in the event of adverse events.

Future directions

In order to evaluate the effectiveness of “App” use for selfmonitoring and for facilitating behavior change, future research efforts are needed. Despite the proliferation of apps on the market, to date, minimal investigation has been conducted to support specific apps.

As I write this, I am aware that technology continues to advance and that, as a consequence, there will likely ensue even more creative ways for individuals to monitor their behaviors and moods.

For a list of references, please contact the author.