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Playing: 1: The intersection of tech and mental health



Kari Ferguson
Jamund Ferguson
Danielle Ramo

1: The intersection of tech and mental health

July 11, 2019

In our first official episode, we'll take a broad look at the convergence of the tech and mental health spaces. We're talking to Jamund and Kari Ferguson, co-organizers of the AnxietyTech conference, and Dr. Danielle Ramo, a clinical psychologist and Research Director of Hopelab.


Jamund Ferguson and Kari Ferguson

Jamund Ferguson and Kari Ferguson are the co-organizers of AnxietyTech -- a one-day conference focused on the intersection of tech and mental health. Jamund is a lead front-end engineer at Thrive. Kari is an author and blogger, and also runs a children’s bookstore.

Dr. Danielle Ramo

Dr. Danielle Ramo is a clinical psychologist by training, and is currently the Research Director at Hopelab. Hopelab is a social innovation lab designing science-based technologies to improve the health and well-being of teens & young adults.

Show Notes

  • 1:23: Start conversation with Jamund and Kari
  • 8:45: On being public with mental health struggles
  • 14:44: On the skepticism of tech in the mental health field
  • 21:48: Opportunities in the digital mental health space
  • 25:09: How technology itself is affecting our mental health
  • 25:52: Talking about AnxietyTech, the event
  • 32:44: Start conversation with Dr. Ramo
  • 36:40: On "human-centered design"
  • 38:52: On "social media intervention"
  • 45:20: On the efficacy of chatbot-delivered intervention vs. human-delivered
  • 47:55: On "hacking mental health"
  • 52:23: Chatting about "loneliness"
  • 58:33: On cultivating a culture where failure is considered necessary for success


Amberley: [00:00:06] Welcome to Fullstack Health, the podcast exploring the intersection between tech and health. I'm Amberley.

Kurt: [00:00:11] And I'm Kurt.

Amberley: [00:00:13] And we are so excited to be bringing you our first full episode today. We are starting off taking a broad look at the intersection of tech and mental health.

Kurt: [00:00:22] First, we're talking with Jamund and Kari Ferguson, the co-organizers or AnxietyTech, which is a one-day conference focused on tech and mental health. Jamund is a lead front end engineer at a wellness company called Thrive, and Kari is an author writing a lot about her personal experience with obsessive compulsive disorder. She also runs a children's bookstore in Washington state.

Amberley: [00:00:47] And then later, we're talking to Dr. Danielle Ramo, a clinical psychologist by training, and currently the research director at Hopelab, which is a social innovation lab designing science-based technologies to improve the health and wellbeing of teens and young adults. She's speaking at AnxietyTech this year, and we'll chat with her about her approach to hacking mental health, and the solutions they're hacking on at Hopelab.

Kurt: [00:01:11] We really appreciate you checking out this first episode, and now let's go ahead and dive in.

Amberley: [00:01:23] All right, today we are so excited to be talking to Jamund and Kari Ferguson. Welcome, you all. Thanks for chatting with us.

Kari: [00:01:31] Thanks for having us. We're excited.

Amberley: [00:01:33] Just to start off, would you all just introduce yourselves?

Kari: [00:01:38] Sure. I am Kari Ferguson.

Jamund: [00:01:44] And I'm Jamund Ferguson.

Kari: [00:01:44] And we are co-organizing AnxietyTech. Basically I have obsessive compulsive disorder, and that's how we got really into mental health pretty fast in our relationship. I had to get help for that, and it was really a hard strain on our family. Jamund was really supportive because he has a lot of mental health issues in his family as well, so he was really understanding. Yeah, I don't know.

Jamund: [00:02:15] Yeah, that's how we kind of got into it. Back to the introduction part though, let's see. I'll tell you just a little bit ourselves. Kari has a blog that she writes occasionally called FaithandAnxiety.com that she works on. She also runs a children's bookstore.

Kari: [00:02:29] Yeah.

Jamund: [00:02:30] So we have a lot of fun things that we work on, and then I was for five years working at PayPal as a UI engineer, and then recently got a job leading front end at this wellness company called Thrive.

Kurt: [00:02:49] Awesome. Very cool. Well, we're super excited to have you here speaking with us today. I guess let's just lead off a little bit. You mentioned something about AnxietyTech, which is a conference coming up in New York?

Kari: [00:03:02] Yes.

Kurt: [00:03:02] And I believe that's in August, correct?

Kari: [00:03:04] It is. It's August 23rd in New York City. Microsoft is hosting the space, so we're really excited to come. Last year we had one in San Francisco, and that was awesome, but now we're going to the East Coast.

Jamund: [00:03:17] Yeah.

Kurt: [00:03:19] Would you like to maybe tell us how did AnxietyTech come to be? I'm sure it's related to issues around mental health and OCD, but I'm just curious, what made you say, "Let's start this conference. Let's do tech and mental health. Let's make that happen"?

Kari: [00:03:38] Right, right.

Jamund: [00:03:39] Yeah. I'll comment on that. First of all, Kari has an event-planning background. She has this degree from BYU in recreation management, and worked as an event planner. So doing events, I of course organized, being involved in tech for a super long time, when I was at PayPal I was always organizing internal conferences and JavaScript events. So events are something that are important to us, and something that we have, I don't know, a connection with. I attend a lot of conferences, go to a lot of concerts, things like that.

Jamund: [00:04:13] I guess it was once Kari got help for her anxiety challenges that she really dealt with undiagnosed properly for like 10 years, but once we started getting help for that and realizing wow, isn't it amazing how much better things can be, we wanted to share like, "Hey, it's awesome when you get help for problems. Isn't that cool?" So we've been to some of the anxiety-

Kari: [00:04:40] Yeah, we went to the annual OCD conference that IOCDF puts on, and we got really excited because they had some technology panels or talks, and Jamund was really excited because he's a programmer, so he's like, "Oh, let's go see what they're doing." It was just do depressing.

Jamund: [00:04:59] Yeah, I mean overall the conferences-

Kari: [00:05:00] The conference was great.

Jamund: [00:05:01] ... were really great. Tons of great therapists and speakers, but when it came to the tech aspect especially, it sort of became apparent that there was a lot of technology that was available in the tech world that wasn't being shared with people in the mental health space. To me it became clear like, "Wow, there should be a mental health technology conference."

Amberley: [00:05:25] So really quickly, what does IO ... you said IOCDF, what does that stand for?

Kari: [00:05:29] That is the International OCD Foundation. Yeah, they're a really great resource for anyone who has obsessive compulsive disorder. They have great resources. They do an annual conference every year. I think we have a few of them coming to AnxietyTech this year, so that's exciting too, their staff.

Amberley: [00:05:49] Yeah.

Kari: [00:05:50] Hopefully they'll bring back some of that to the conference that they have.

Jamund: [00:05:53] Yeah, and I'll just throw out there like-

Kari: [00:05:55] But they're great, yeah.

Jamund: [00:05:56] ... for people out there dealing with mental illness, and obviously there are a lot of us, there are a lot of these organizations that exist. They're big international organizations that put on events that are really helpful. If you're someone dealing with depression or anxiety or a whole host of them, I definitely recommend checking out what's out there beyond just maybe a local therapist. Sometimes it's really powerful to see what are the leaders in this space talking about because it might be different than what your local people are discussing.

Kari: [00:06:28] Right.

Amberley: [00:06:29] So it sounds like really a combination of, Jamund, your tech background and recognizing this gap in the conversation from the mental health side of it, the mental health space. Was there a particular thing that helped you, Kari, in this journey that you all were talking about that made you want to surface particularly the opportunity in the mental health space with tech?

Kari: [00:06:53] Yeah. I think originally we were looking at, you know, there's a lot of great psychologists and therapists, but they're not so up to date on the technology that's there to use, and it's hard for them to get training on that. I think that's originally why one of our ideas for AnxietyTech was almost more for mental health professionals to be able to find out what was going on in the tech industry so that they could use different technologies in their practice.

Kari: [00:07:21] Like one of my therapists here in Portland, he wanted to get into VR because there's certain challenges that people have, like they're afraid of flying, or they're afraid of spiders or vomiting or different things like this that you can't really do exposures as we call them because you can't just be like, "I'm just going to go take an airplane flight two times this week to work on my fear of flying" because it's just cost-prohibitive. But with VR, you can. It's immersive, and it's like you're taking an airplane flight.

Kari: [00:07:55] That's really what the original, I think, concept was, was to bring these two industries together. So yeah, I was inspired by my therapist and by different things that I was seeing there. But then as we started planning and reaching out to the tech community, we found there were a lot of people who wanted to talk about the mental health in the tech community, like programmers facing burnout or stress or anxiety, different things like that.

Kari: [00:08:19] That's kind of changed our vision a little bit for the conference, and we incorporated a lot more of that. That's why this year we have two tracks basically. One that's more focused on the technology that is helping mental health issues, and then another one which kind of focuses on the mental health of the tech industry and of the workers and people there.

Jamund: [00:08:42] And the products that we're building.

Kari: [00:08:45] Yeah.

Kurt: [00:08:45] Yeah. It just seems like almost the perfect storm that happened, Jamund, with your background, and then Kari, with your issues and recognizing that space. I wanted to sidestep a little bit and just ask how difficult has it been dealing with being so public and vocal about your issues with anxiety? Did it take a while for you to get comfortable before you said, "Hey, let's have a conference, and I'm going to start a blog"? I was just curious if you could maybe talk about that for a second.

Kari: [00:09:21] Sure, yeah. Like Jamund said, I kind of went for about 10 years without really knowing what was going on or accepting what was going on with myself and being like, "I don't need to get help. I don't need to get help." Then finally something just clicked, and I kind of had a big breakdown as probably a lot of people with mental illness can relate to. Things just build up, and then suddenly everything implodes. I knew that I had to get help because I just couldn't function anymore.

Kari: [00:09:51] That was a really, really difficult time, and eventually, I don't know. I had a personal blog, and I wrote a little bit about that. I got a lot of, on that blog was just friends and family, and then I got a lot of positive response from people who related to that. Then we moved to the Portland area, and there was someone who became my friend who came up and she said, "I kind of blog-stalked you," as we do in our society today. She said, "I have similar issues."

Kari: [00:10:27] So we developed this relationship based on talking about our mental health with each other, and I think that was kind of the first time I really talked about it openly with someone who wasn't in my immediate family really. I saw that other people were dealing with this, but no one was really talking about it, specifically in our faith, in our religion. So I started this blog specifically about religion and anxiety because I felt like it wasn't discussed very much, and it got a lot of positive ... People really resonated with it because it wasn't being discussed.

Kari: [00:11:02] And yeah, it is hard. It's really difficult to write about, and I started writing for The Mighty, which is this great website that deals with mental health and physical disabilities, and got a lot of response, very positive feedback about that. Then eventually I wrote a book about my experience and got that published. I think it was really the book, which is called The OCD Mormon, it was really that book after that I was like, "We should do a conference because so many people want to talk about this. I'm getting so many comments on the blog and different things. This needs to be something that we talk about because people obviously want and need help."

Jamund: [00:11:44] And there needs to be a forum to deal with those issues. I'll comment a little bit on the tech side. As Kari mentioned before, we didn't really go into it thinking about problems of tech workers.

Kari: [00:11:55] No, yeah.

Jamund: [00:11:55] I was thinking more about ... I literally started on a little bit of my AnxietyTech journey by trying to make virtual reality using what was called reactive VR at the time. I was like, "I'm going to use reactive VR, and I'm going to make exposures for Kari to simulate situations that would cause her stress so that she could put herself in those." I was really, really bad at it, and I thought, "Well, maybe other people know how to do this better than me because I'm really bad at making virtual reality apparently."

Jamund: [00:12:23] Like she said, as we started talking to people in the tech community, there was interest in that side, but so many more people said, "Hey, we have a story we need to tell about how we're dealing with depression, burnout, anxiety" and a whole host of other challenges in tech.

Kari: [00:12:36] Yeah. It's really difficult I think for people to tell their story in many cases. Just getting back to the question, but I feel like when people hear other people tell their story, it enables them to open up, and it enables them to be like, "Whoa, I am dealing with that too."

Kari: [00:12:54] That was my first experience in therapy, in group therapy. Everyone just introduced themselves and said what their problems were and what they were dealing with. I was just like, "Oh my gosh! I've dealt with so many of these things, and I didn't realize that that was OCD. I just thought that was just me." So being able to discuss and to hear other people's stories is so meaningful.

Amberley: [00:13:16] Yeah, I really love that these conversations are happening more openly. I mean, I also didn't talk about it super openly online for a long time, like Kurt, and started posting a little bit more about when I was struggling more with depression and everything. That's just an ongoing process, and yeah, I think opening up those conversations and contributing to the destigmatization is so important.

Kari: [00:13:40] Right.

Jamund: [00:13:41] I'll also just throw out there one thing that is hard is that when people recognize they have a problem, actually going from that stage to getting real help can be super daunting. Obviously admitted and finding you have a problem is important because there are a lot of resources, but ultimately getting the help and the right kind of help can be super hard, and that's where-

Kari: [00:14:00] So hard.

Jamund: [00:14:00] ... I think tech has a huge role to play. Whether it's just discovering good options for support, whether that's online or group or in person, but also potentially hopefully new technologies that will actually help people specifically whether it's the VR stuff we talked about or chat therapy, chatbots like Wellbot. There's just a lot of things that may be able to help, but I think we're starting to catch a little bit of insight into, and obviously there's been an uptick, upsurge, I don't know, a big surge in investment and interest in finding solutions because these problems are so universal.

Kari: [00:14:44] Yeah.

Amberley: [00:14:44] Yeah. Just a slightly different thought. I read in one of your articles that you have the impression that many professionals in the mental health space aren't aware of, or what caught my eye was even skeptical of the capacity that tech has to help. I was thinking about that when you were talking about it has the potential to lower the barrier to finding help. Like it can be more daunting to call someone, or to try to meet someone in person, but if you can do it from your phone or your computer, that can make it less daunting.

Amberley: [00:15:25] Given that, why do you have this impression that mental health professionals are skeptical?

Jamund: [00:15:34] I'm happy to tell you about that. Yeah, I think, and again, there's many different mental health professionals that are super excited about this stuff, but I will say that as a group, right, they really want to make sure they're helping people and you're not giving them false hope, or you're not giving people things that are vaguely going to help them, but not really going to take them to where they need to be.

Jamund: [00:15:56] The type of therapy that therapists give, whether it's cognitive behavior therapy or some of these acceptance commitment therapy, these are proven, well-understood, science-backed things that work. The problem is they work for just a tiny percentage of people that have access to that type of care.

Jamund: [00:16:16] What technology's trying to do is find ways to give more people access to that quality of care, but in reality many of those tech solutions aren't really as good as the premier alternative, which is traditional therapy, which is doing very well in the mental health space.

Jamund: [00:16:35] I think there's valid reasons for skepticism because you get sort of arrogant tech people saying, "Oh, I'm going to solve depression with an app." People are like, "Oh, really. Good luck with that." But the truth is there are some things that are really working, and people are doing some great research. But yeah, I kind of appreciate the skepticism.

Jamund: [00:16:56] And also because I think ... There's so much to it. The other thing too that I'll mention is because of how long it takes to get certified to become a mental health professional, many of the people that are mental health professionals, like the therapists that we're aware of, that we work with, are not of growing up using technology every day. They're less likely to be familiar with the latest tech, the internet smartphone stuff that people, maybe millennials and younger are very familiar with. It's kind of a generation gap.

Kari: [00:17:30] And I think a lot of the millennial younger generation who maybe want to get into being a therapist or things are almost daunted by how long it takes to become an actual psychologist or things like that, and you see a lot, at least I've been seeing a lot more of licensed social workers or different things who they're not PhDs, they're not psychologists, but they're mental health professionals. They have all these, I don't even know all the acronyms that they have now. I feel like we're seeing less psychologists, which is just that's the way it is, it's fine.

Kari: [00:18:07] So yeah, like Jamund said, there is this generational gap. Yeah, it's difficult. And there is something to be said about going to therapy and talking to a real person versus talking to a chatbot. Is AI really as good as a real person? These kind of-

Jamund: [00:18:26] No.

Kari: [00:18:26] No, yeah.

Jamund: [00:18:28] It's definitely not. But there's excitement-

Kari: [00:18:31] But yeah.

Jamund: [00:18:33] ...there, and there's also a challenge there.

Kari: [00:18:34] But yeah, but like I said, there's just not enough therapists to go around for all the people who have mental illnesses and mental health problems. Like you said, it's daunting to call someone or to go in real life and make an appointment. Then even if you get that courage, they might not call you back for two months, or ever because they're so busy. So it's like you put out the effort, and then nothing happens and you don't get the help because they just can't. There's too many people.

Kari: [00:19:04] Yeah, who need help. Yeah, I get comments from people all over just like, "how do I find a therapist? My kid, I think they have OCD but they can't get into a therapist because there's no one around, or they're too busy." So I think technology could definitely help with some of these issues and some of these people who can't get into help or can't find help in their area at all, period.

Kurt: [00:19:30] Yeah. I completely agree with that. You literally just said what my experience was when I decided that oh, I need to see a therapist. I need to see a professional. Trying to do this on my own clearly is not working. So about three quarters of the way through 2018 I started this process, and another thing I want to touch on that was a huge blocker was insurance.

Kari: [00:19:53] Oh yeah.

Kurt: [00:19:54] I would search and find a therapist who I felt comfortable even reaching out to, because that alone is hard enough, and then it's not in network. So now it's either $250 per visit, or I have to start my search all over again and try and find someone who my insurance will take, if I even have insurance that covers something like that. Yeah, huge blocker. It just sucks because people who suffer from depression are also the ones most likely to after even getting the courage to have an initial effort, to then give up, right?

Kari: [00:20:26] Right.

Kurt: [00:20:27] That's part of the actual symptoms of it, like, "I'm not going to continue to push forward if I'm just going to sink further into depression" and be like, "Oh great, I can't even get a therapist." Yeah.

Kari: [00:20:38] Exactly, exactly. Or yeah, like you said, just who you feel comfortable calling. Then what if you do meet them and you don't connect with them, or you don't like them? Then you're back at square one.

Jamund: [00:20:48] It's so hard.

Kari: [00:20:49] It's so hard to find a good working relationship with a therapist.

Jamund: [00:20:53] When Kari was having a really bad spiral a couple years ago, it was like she wasn't in any state to call anybody. She wasn't calling a therapist. I was literally calling therapists.

Kari: [00:21:06] He was calling for me.

Jamund: [00:21:07] And they're all like, we were looking at treatment programs where you stay there for a couple of days, and those were all booked for months ahead of time. But realistically, what's happening right now is that there's not enough mental health professionals to help all the people that are struggling.

Jamund: [00:21:25] What tech is looking to fill that gap is to scale that out. In many cases, it's not giving them full-on therapy, but it's providing them with some help, or even just more information so that they can understand the problem.

Kari: [00:21:38] Emergency care for those months that you're waiting to get into the therapist.

Jamund: [00:21:41] Yeah. Something to help you while you're waiting to get the professional care that you need.

Kari: [00:21:47] Yeah.

Kurt: [00:21:48] Yeah, that makes a ton of sense, and it seems like there's a ton of room there. I'm curious to know also what other ways do you feel that technology could help? It seems like through placement, or like you said, assistive care, or augmented care if you will. You talked about VR and immersion and being able to recreate situations, which was something I never thought about, but that's absolutely genius. What other things really stand out to you that people are doing or talking about? Yeah.

Jamund: [00:22:18] Oh wow. There's so much interesting innovation happening in this space. I'll just quickly go through a couple things. One concept is teletherapy. It sounds super obvious, like oh, instead of going in person we'll do a Skype call or something like that. But actually figuring out how to do that well has been a big challenge.

Kari: [00:22:37] And it's hard just with even legal requirements in different states and, you know.

Jamund: [00:22:42] Every state has different legal requirements. You can't really do therapy across state lines. So there are a lot of challenges to making that work. Teletherapy is going to help a lot of folks.

Jamund: [00:22:51] There's a lot of technology innovation around finding you, I can't remember if it's called precision medicine or something like that, but it's like finding you the exact person that's going to help you for your problems. Because one of the things about anxiety disorders and mental health issues is that you can go to the wrong person without the credentials and they won't really be able to help you. Maybe they'll prescribe you some medication, maybe they'll do this or that, but they're not really going to be able to help you get to the root of the problem that you're dealing with. All sorts of technology that can help you better diagnose the problem and find the right person to help you just to connect you with the right mental health professional could be really powerful.

Jamund: [00:23:31] On the treatment side, we mentioned virtual reality, which is really cool. There's a lot around apps that do cognitive behavior therapy, which is a popular type of therapy for a lot of anxiety disorders. There's different ways. That can be a chatbot, that can be something that reminds you. Basically the idea is that it challenges you to, like if you're worried about something, it challenges you to like what's the worst thing that could happen, and challenges you to try and do the hard thing that you're scared of to realize that it's not going to be so bad. There's a lot of apps that try to do that now, and a lot of work that's going in there.

Kari: [00:24:13] Wearables.

Jamund: [00:24:14] Yeah, there's wearables to detect when you're having problems, but I think ultimately this whole space is so new that I don't think the big solution or big answer has really happened yet. I think that people are ... Oh, there's even virtual reality art therapy and more interesting things that are happening there besides just exposing people to scary things.

Kari: [00:24:37] And I mean there's also training that doctors or people who are interested in becoming mental health professionals can do online. Like I did an online course on cognitive behavioral therapies so I could learn more to help other people as well. There's also trainings that happen online.

Jamund: [00:24:53] Yeah, and of course all the mindfulness and meditation apps like Calm and Headspace and stuff like that. And of course plenty of ... Yeah. There's a million things going on in tech with regards to this stuff. There's medication reminders. There's so many more things.

Jamund: [00:25:09] I'll also mention, sorry to keep piling on this list, is another aspect that we haven't gotten to yet, and I don't know that we'll have tons of time to get into, is how is technology affecting our mental health?

Kari: [00:25:23] Yeah.

Jamund: [00:25:24] Kind of the reverse. Not technology to help us, but how is the technology like social media and mobile and everything affecting our mental health negatively? Some of the speakers that we invited to speak both last year and this year are talking about how do we build technology that's less stressful? Calm technology, or technology that's more emotionally aware that can detect our emotions and maybe better understand us so that it can serve us more effectively.

Amberley: [00:25:52] Going back to AnxietyTech just a little bit, I was thinking-

Jamund: [00:25:55] Yeah, let's do that.

Amberley: [00:25:58] ... I started my career in the nonprofit area, and we had this constant sense that our community was really engaged, but really insular. Like in a lot of ways it was like preaching to the choir with the same people attending the same events and conferences and things like that.

Amberley: [00:26:18] I'm curious if you have any thoughts on how you're trying to broaden the interest in something like AnxietyTech, or other people doing similar things, how you're trying to broaden that?

Jamund: [00:26:33] It's really hard. Okay, so-

Kari: [00:26:35] It is, yeah.

Jamund: [00:26:35] ... last year we got this venue for 700 people. We were very ambitious, and we're like, "This is so important. Everyone is going to be there."

Kari: [00:26:42] Everyone will come.

Jamund: [00:26:43] We probably sold 100 tickets, and then-

Kari: [00:26:45] Well, that's a lot.

Jamund: [00:26:47] ... we had another 50 volunteers or speakers or other things like that. So we probably had 150 people last year. It was a great group. Legitimately some really interesting folks.

Jamund: [00:27:01] We are looking at partnering with another group called Hack Mental Health. Steven and Anne, who are the cofounders of that group, are going to be speaking at our coming this year. They set up these hackathons around mental health. It's mostly around college campuses, but they have been getting hundreds of people at their event.

Jamund: [00:27:18] For me, because I'm a programmer, I'm in the JavaScript community, last year when we first held this thing I made this article on Medium about why I thought we needed a mental health technology conference and how it kind of reminded me of the first time I went to JSConf, which is a popular JavaScript conference, a couple years ago and I met all these people that were doing things, and it really inspired me to be my very best in JavaScript land.

Jamund: [00:27:45] I was hoping that this would be a thing that inspired people to really think about what are they doing in tech. Are they contributing to making people more stressed out and more anxious, more push notifications cramming down your phone, or are they contributing to making a technology that's really helping people, or at least contributing more to society.

Jamund: [00:28:06] I kind of thought of it in some ways as a personal journey of how can we inspire people to use their amazing skills that they've learned in this crazy industry to add more good to the world and solve some real human problems.

Kari: [00:28:22] Yeah. It is difficult to try and expand the group, I guess, and we've just been really grassroots going at it I guess just trying to snowball. Getting different Twitter followers. Yeah, we'd love to get the word out even more. We get people like, "I never knew this existed. This is so amazing!" So as people share on Twitter and different social media apps and stuff about AnxietyTech, that will definitely help.

Kari: [00:28:50] Like we said, I'd love to at least get more of the mental health industry in as well. We're pretty good with the tech users because they're using the technology. They're using Twitter to find out-

Jamund: [00:29:03] Frankly, the people that love our conference the most, at least last year and I think this year it's the same, is design and UX people because I think they fundamentally are thinking about how does this technology affect the user. We had a lot of folks from Apple last year from doing design or working on some of their Apple health stuff. We have a lot of people this year already who are coming that I know have a design and UX background.

Jamund: [00:29:26] I don't know about all these communities. I literally am fairly stuck in my JavaScript world, and I don't have a huge reach or a huge following or anything like that. So I would say yeah, we're struggling to figure that out. We're trying to bridge with other people doing similar things as much as possible, like yourselves and others. But ultimately I think each time we have this event, I think it just grows organically. I think that's frankly the way that it's going to work. It's just going to grow organically until literally it's 7,000 people.

Kari: [00:29:56] Yeah, and I think that's why we're also trying to go to different parts of the US, and hopefully we're trying to do London next year because we have a lot of European and people in the UK who are like, "We want to be a part of this."

Kari: [00:30:08] Just as we go to different places, hopefully the people in those places will be aware, and then we're just building the community very organically. It's difficult.

Jamund: [00:30:17] AKA slowly.

Kari: [00:30:18] Slowly. Step by step.

Jamund: [00:30:18] I don't know if that's a good answer to your question. The answer is we don't know. We're struggling with that.

Amberley: [00:30:25] Well, it was kind of a "got you" because I think that's a problem with most communities. It's something that a lot of people try to tackle.

Jamund: [00:30:32] We learned last year that unless your company is directly in this space, you're not likely to get your employer to pay for you to go to AnxietyTech because it's not contributing enough to people's job that they're going to be like, you know, many tech workers are allowed to go to maybe one conference a year, if that. So for them, in JavaScript they're looking at Fluent Conf or JSConf or React Rally, which I think is the same time as AnxietyTech this year. One of these types of conferences. What we learned is people are oftentimes paying for this out of pocket, so we've got to make it affordable for them so they're more likely to come.

Amberley: [00:31:10] It's funny that you mention React Rally because there's where Kurt and I met in and for the first time, and I was also totally going to go to AnxietyTech. I'm going to React Rally this year, and Kurt is not, but yeah.

Jamund: [00:31:21] It's a good conference, and I don't know. Jamison, I know Jamison. He's awesome. So.

Kurt: [00:31:27] No. I just wanted to real quick say one, thank you for putting this on and putting this together. There's a lot of people who need it. I know it must be a ton of work and really difficult to do. So I think it's just amazing that you all are trying to make a difference in this space and really help people. Yeah, it's been amazing having you on here and talking with us, and we appreciate it so much.

Kari: [00:31:52] You are welcome.

Jamund: [00:31:53] Thanks, yeah. Boy, I'll just say this. If you're interested in mental health and technology, if you want to learn more about helping people in this space, or if you want to learn how to make tech less horrible for users and people, I would love for you to try and come out to AnxietyTech. I know New York is far away, but the conference is very inexpensive, and it's a good place. It's not like a fancy coming. We're not giving you a lot of free stuff or anything cool like that. It's just some really cool people there who are trying to make a difference in the world.

Kari: [00:32:29] Yeah.

Kurt: [00:32:31] Awesome. Thank you so much.

Amberley: [00:32:33] Yeah, thank you guys.

Kari: [00:32:34] Thank you.

Jamund: [00:32:34] Thanks so much, friends.

Kurt: [00:32:44] All right, and thank you for joining us, everybody. I'm super excited because we have here with us Dr. Danielle Ramo. Dr. Danielle Ramo is a clinical psychologist and research director at Hopelab.

Kurt: [00:32:56] Thank you so much for being with us here today.

Dr. Ramo: [00:32:58] Thank you for having me.

Kurt: [00:32:59] Would you like to maybe take a minute to introduce yourself, let everybody know essentially who you are? Yeah, anything you wanted to add to that?

Dr. Ramo: [00:33:09] Sure. You mentioned that I'm a clinical psychologist by training, and that means that I have been working in the fields of mental health and particularly substance abuse for most of my career. I'm trained as a therapist, but I'm not currently practicing. I've been conducting clinical research since I got my PhD from UC San Diego about 15 years ago.

Dr. Ramo: [00:33:34] I was leading a research program at UC San Francisco on digital interventions to support adolescent and young adult mental health. That primarily meant using social media to try to intervene on health risk behaviors. Things like cigarette smoking cessation, heavy episodic drinking AKA binge drinking.

Dr. Ramo: [00:33:59] But I also got real interested in how health was communicated on social media. That included everything from mental health kinds of conversations like bullying and perhaps suicidality, but also substance use. I have some research papers, for example, in how prescription opioid misuse is being represented on Instagram, or how conversations about new modes of cannabis delivery like vaping and dabbing are happening on Reddit.

Dr. Ramo: [00:34:30] That led might to think about moving this research to Hopelab because we build digital tools to support adolescent health and emotional wellbeing, and it felt like the perfect next step to do this work.

Amberley: [00:34:45] How would you describe what makes Hopelab special? Because it sounds like a perfect match for what you're interested in and what you're working on. What makes it different from other labs?

Dr. Ramo: [00:34:59] I got lucky, frankly, that Hopelab even existed. I was leading a research lab in the department of psychiatry at UC San Francisco, and there are a lot of interesting things happening in digital mental health and academic medicine. But what I came to notice is that there is a lot of opportunity outside of academic medicine to make interventions that we might know work more interesting to people, more usable, and to take advantage of the amazing opportunity that social media data provide and digital data provide to understand so much about the people that are using interventions.

Dr. Ramo: [00:35:46] I had this sense that collaboration was key. I knew that human-centered design was an emerging field that could help researchers think more about how to make tools that people would actually want to use and incorporate a deep understanding of lived experience of users. I started to be curious about how I might have those collaborations.

Dr. Ramo: [00:36:14] So enter Hopelab. Hopelab, as you said, is a social innovation lab that partners behavioral science with human-centered design as well as an understanding of market viability of digital tools, specifically as they relate to adolescents and young adults. That is a very unique partnership.

Amberley: [00:36:40] That's amazing. Stepping back for one second, I'd be interested how you would define human-centered design for someone who maybe isn't familiar, or doesn't really have a working definition of human-centered design.

Dr. Ramo: [00:36:57] Sure. I am a clinical researcher by training, and I started to have colleagues who would go through trainings in the process of human-centered design in sourcing information about a design process or a product directly by deeply understanding the problem itself, and then innovating a solution that might be really different from the way that client or the person who has this problem has thought about it before, and maybe quite different from how even experts have thought about it before.

Dr. Ramo: [00:37:44] The human-structured design process that was pioneered at places like Stanford and now has grown into the Stanford Design School, and places like the IDEO design consulting firm as well as other firms help people think about the lived experience of a person or group of people that has a problem, and how the problem can be solved through multiple different channels and arenas. So they go out in the world, they experience the problem through ethnographic research procedures. They talk directly to people who are related to the problem, and source creative, innovative ways to solve that problem.

Dr. Ramo: [00:38:34] That's really different from how it's done in the clinical research world. I'm used to using theory to think about a problem, let's say something like depression, and starting from there.

Kurt: [00:38:52] To focus it on the one part where you say social media intervention, can you define a little bit more what you mean by that as far as how you're actually using social media to target and interact with these people?

Dr. Ramo: [00:39:07] Sure. I can talk about it from my personal experience as well as what we're doing at Hopelab. In my own research, I've been using social media to help people make healthy lifestyle changes, and that has included quitting smoking as well as trying to reduce binge drinking among 18-25-year-olds.

Dr. Ramo: [00:39:31] In the case of my research program, we have recruited people primarily online and delivered evidence-based treatment. Treatment that we know works in a counseling setting or online. But we've been delivering it through Facebook secret groups. We put people in Facebook groups who are similar in motivation. So some who are motivated and ready to make changes, let's say, in their cigarette smoking go in one kind of group, and those who aren't ready go in another kind of group, and deliver intervention that's tailored to the motivational state of a given user.

Dr. Ramo: [00:40:10] Then the clinical trials that I've been running in my lab evaluate how people are engaging with these interventions as well as whether these interventions result in health behavior outcomes that we care about including in the case of smoking, smoking cessation. Key there is not just to ask people are you still smoking at the end of the intervention, but actually getting biological confirmation of whether they're smoking or not.

Dr. Ramo: [00:40:39] At Hopelab, I was very excited to find that they care also about measuring the health outcomes that we want to see change among young people. They were also using social media when I came here, and I've been helping to enact and write up a clinical trial of a social media-based chatbot for young people with cancer. That product is called Vivibot, and I'd be happy to tell you a little bit more about it. It's a chatbot that's on Facebook messenger that's available publicly. It's online and listeners can feel free to take a look at Vivibot if they're interested.

Dr. Ramo: [00:41:26] It is tailored to young people who have undergone cancer treatment. That's a time after treatment is over that we know is a vulnerable time for young people, and a time when they're often dropped. They're not as engaged with the clinical services that are available let's say in a hospital system, and they're coming back into the world. Into their communities, their families, their social relationships, in a totally different way than when they left because they had a cancer diagnosis and they needed to undergo treatment. It's a time when young people are at risk of developing anxiety disorders, depression, suicidality and even committing suicide.

Dr. Ramo: [00:42:11] So we wanted to develop a tool that would be available 24/7 on a medium that young people are on all the time, and in this case it was Facebook messenger, delivering skills that we knew worked to improve mood among people with severe health problems. In this case, it was positive psychology skills. Vivibot delivers seven different positive psychology skills. Things like expressing gratitude; practicing mindfulness, which is present, focused attention; conducting acts of kindness; and seeing the positive in a situation that might not be going so well.

Kurt: [00:42:53] I suffer with depression and drug addiction as well. From the years of 18 to 22 or 23 is when I think I was really at my worst. Just having a way-

Dr. Ramo: [00:43:05] Those are vulnerable years.

Kurt: [00:43:06] Yeah, they really are. It's just so amazing putting this out in a way in which people at that age, in this day and time there wasn't Facebook messenger when I was that old, but it would've been cool to have a service that was text-based or something, because that was just becoming a thing. Something like that, just a way for me to connect with people. It felt very hard to go into a hospital and seek help immediately. It seems like such a large jump. So yeah, something like this, it just seems amazing.

Dr. Ramo: [00:43:36] I couldn't agree more. We landed on social media as a field after a lot of different other digital media were tried and evaluated first. So a lot of interventions, and this goes for the broader field of digital mental health and digital substance use interventions.

Dr. Ramo: [00:43:57] Text message was definitely something that was tried early on and found to be effective in two ways, both to reach people who wouldn't otherwise be able to go to treatment. Let's say they're in a rural area, they don't have access to certain treatments that might be available face-to-face, or to supplement treatments. Often in mental health things that we know work really well to improve depression symptoms, things like cognitive behavioral therapy, groups or individual sessions, one of the key features of those interventions is doing homework. So actually working on the skills that you're learning in a treatment group outside of that group. A text message intervention or a computer-delivered intervention can help reinforce practicing those skills outside.

Dr. Ramo: [00:44:44] So just having that digital piece was shown to improve all sorts of mental health outcomes for interventions like CBT, but also they were able to be available at night and on the weekends when clinicians weren't necessarily available. Now we have a whole world of apps and social media that is a means of connecting with all different kinds of people, but especially younger people because this media is entirely integrated into their lives.

Amberley: [00:45:20] I love the idea of meeting people where they are. I'm curious from a research standpoint, have you all evaluated the efficacy of a chatbot response versus a real human? I understand the limitations of having a real clinician human person on the other end of a line, be that text-based or voice-based or whatever isn't realistic a lot of the time. Like you said, at nights, weekends, et cetera. But purely in terms of what works, do you all have any conclusions comparing how effective the chatbot is compared with an actual human delivering that?

Dr. Ramo: [00:46:07] That's a great question. The field of chatbots for mental health intervention is really new. That means that most trials, clinical trials at all, which means things that actually randomize users to one group or another, haven't yet come to the point where they're comparing engagement with a chatbot to engagement in a similar intervention with a human.

Dr. Ramo: [00:46:35] We'd love to be able to get to that point. We aren't there quite yet with Vivibot. Where we started with Vivibot was asking the question was engagement with Vivibot going to address and have clinically significant or meaningful reductions in depressions, reductions in anxiety, and improvements in mood compared to a limited engagement in the same medium? We started there, right, with kind of a simple controlled trial to just say are people engaging with this thing, and does it seem like it's going to impact the health outcomes we care about?

Dr. Ramo: [00:47:17] An important next step is what you were getting at, is comparing the chatbot format to the same kinds of positive psychology skills delivered either with a human face-to-face, or with a human let's say over a computer. And those trials just haven't been done yet.

Amberley: [00:47:37] Yeah, that makes perfect sense. I would love to sidestep a little bit. I read about you being a judge at, what was it, Hack Mental Health's-

Dr. Ramo: [00:47:49] That's right.

Amberley: [00:47:50] ... mental health hackathon?

Dr. Ramo: [00:47:51] Yes.

Amberley: [00:47:55] There was a line from, you wrote a reflection on it, and you said, "We hack mental health every day at Hopelab." I'm wondering between hacking mental health every day at Hopelab and hacking mental health in the hackathon, what does that mean to you? What is hacking mental health to you?

Dr. Ramo: [00:48:12] I will say it is easier for me to be able to hack mental health at Hopelab as a full-time job because I sort of hack mental health in my head almost all the time than it would be for me to be actively hacking solutions through the hackathon format all the time because I was beyond impressed with what solutions hackers were able to come up with related to mental health in a 36-hour period when I was lucky enough to be a judge at Hack Mental Health's West Coast event in March.

Dr. Ramo: [00:48:48] At Hopelab, we are trying to come up with digital solutions that move the needle on mental health and other kinds of health outcomes related to young people. That requires a certain amount of iterating and hacking to get right. That doesn't necessarily mean we're hacking in the classic engineering sense. We actually don't have engineering in house at Hopelab. We tend to do a lot of consulting and progress with firms that can help us build the tools that we are designing and evaluating at Hopelab.

Dr. Ramo: [00:49:30] But we are iterating on our solutions all the time. We don't start with a mentality that we know what works and it's going to be easy to put something out in the world that people will want to use and it will work. Instead, we come at it with an attitude of curiosity, yes, expertise in the behavioral science side by saying we understand that there is a wealth of literature around a tool like positive psychology interventions, or we know what other companies are doing in the chatbot space. But we don't assume from moment one that we are going to know how to solve the problem the first time we try.

Dr. Ramo: [00:50:19] That's why I like to refer to what we do as hacking, and I think of myself as someone who is a curious problem solver rather than someone who is an expert when I approach a new problem.

Amberley: [00:50:37] Yeah, and one of your other takeaways from that that I remember reading is you mentioned the ... this ties back to the human-centered design approach that you were talking about earlier, but the reduction of stigma mental illness in wider culture is leading to more creative solutions?

Dr. Ramo: [00:51:02] Yup.

Amberley: [00:51:02] Why do you think that is?

Dr. Ramo: [00:51:04] I think there is a real movement to reduce the stigma of mental health problems, which is generally a wonderful thing. However, in part it's been brought on by the massive increase in the experience of some mental health problems and deep and sad consequences from mental health problems.

Dr. Ramo: [00:51:31] For example, the suicide rate among young adults is higher than it ever has been in previous years. We've done some work at Hopelab on understanding the current state of loneliness among young people and young adults aged 18-25 are lonelier than any other generation ever has been. So there are problems like that that mean we have to be more aware of the role mental health problems and wellness play in our society.

Dr. Ramo: [00:52:07] That's a good thing that more people are thinking about it and caring about it, but unfortunately it also means that there is a real mismatch between the experience of problems and what solutions are currently available.

Kurt: [00:52:23] Just to touch on the bit about loneliness. If I remember correctly, so Hopelab also had a project called Destroy the Myth, which is the myth being that loneliness is not the same as being alone. Are there any maybe key insights or things that you learned from that project that maybe would be interesting to people in the tech community, which can also be kind of a lonely field, especially for developers and other people who might work remotely? But yeah, was there anything that you felt might be interesting or useful to share?

Dr. Ramo: [00:52:55] Sure. Hopelab centered on loneliness because we found that loneliness was being experienced at unprecedented levels among Gen Zers today more so than even older adults. Loneliness tends to be thought of as a problem of older adulthood, but just looking at college students in the United States, for example, a third of college students say they've felt very lonely at some point in the last month, and two thirds say they felt very lonely in the last year. That's a lot of folks, right? A good majority.

Dr. Ramo: [00:53:37] So we found it important to think about loneliness, and also there's a limited number of interventions, or almost nothing out there, that looks directly at how to help people be less lonely. Part of the project that you're describing was a year-long effort to delve into loneliness among young people, and it helped us to land on the focus of college as a time that combines a particularly vulnerable period, and one in which there's opportunity to intervene.

Dr. Ramo: [00:54:17] We are developing an app right now called Nod that is supporting college students making social connections in order to support their own social goals. That could be anything from networking more to making more friends to feeling less isolated in a time in their lives when people often have really high expectations of what will happen in college. That they'll go there and they'll immediately find their tribe, make the best friends of their life, but often when they get there, it's not necessarily the experience that they expected.

Kurt: [00:54:57] Yeah, I can see that being very true. Can you maybe talk just a little bit about that app Nod? I'm pretty curious just to know how that would work.

Dr. Ramo: [00:55:07] Sure. Nod allows users to meet their own social goals. They start out by sharing, if they'd like, whether they'd want to have a particular social goal, or they can just explore building connections. We allow them to do that in two ways.

Dr. Ramo: [00:55:28] The first is that we give them challenges. These are active challenges out in the world. They're kind of mini missions that encourage students in college to skillfully socialize out in the real world. So things like dare to leave your dorm room door open this whole week, or walk down the campus and look five people in the eye and say hello this week.

Dr. Ramo: [00:55:57] That's sort of the external part, but there's also an internal piece that's key, which is processing setbacks with compassion because things don't always go so well. You might look people in the eye, smile, say hi, and they don't look up from their phones, right? That can make people feel really bad. So how do you couple that external part with a piece of reducing the pressure that we can put on ourselves to always be perfect.

Dr. Ramo: [00:56:22] So we also have reflections in the app. They're short in-app exercises that can help students process social experiences after they happen to try to reduce the self-criticism I was talking about and build resilience so they can go out in the world and try something again.

Amberley: [00:56:40] I'm curious, are these tried and true cognitive reframing techniques and you all are primarily exploring the delivery method with this app?

Dr. Ramo: [00:56:52] Yeah. Great question.

Amberley: [00:56:53] Like it's more about access?

Dr. Ramo: [00:56:54] A lot of digital health interventions have the luxury of being able to start with we know what works, and we just want to put the thing in a new medium and figure out whether that actually works. That's what we did actually with our Vivibot intervention. We knew positive psychology skills already had promise and were able to change health behaviors and mental health before we came at it from a chatbot medium. So the key question there is will this medium actually be engaging and be effective for users?

Dr. Ramo: [00:57:26] With Nod and the loneliness space, it's a little different. There really aren't interventions for loneliness, so we couldn't start with what works in the loneliness space and just put it in an app and see whether people will use it. We are sourcing our content from interventions that we know work to help people improve the way they think about situations. That is interventions like cognitive behavioral therapy as well as compassion-based interventions that do already have some efficacy around other mental health problems. But to be honest, we're creating something really new because the science of loneliness is fairly new in and of itself.

Dr. Ramo: [00:58:11] I also think, as you kind of alluded to in your question earlier around loneliness in the tech industry being high, we're also seeing it at unprecedented rates among a generation that's also digitally connected and more comfortable than ever sharing things that are very personal in an environment for everyone to see.

Amberley: [00:58:33] I know that we're too quickly running out of time. One thing I really, really wanted to chat about was something that I find super important. One of the things that again I read in your writings was about cultivating a culture where failure is not just acceptable, but fundamental to eventual success.

Amberley: [00:58:58] To me this is so important because it's really critical, particularly in the tech community, relating to a lot of people suffer from impostor syndrome. Can you talk a little bit about the shift to thinking of failure as critical for success?

Dr. Ramo: [00:59:17] Yeah. Sure, and actually it might be an interesting lens to think about because as a clinical psychologist, my frame is about how our thinking about failure can influence what motivates us to do anything, and that includes to iterate on a problem in a technology space, but also in any way in our lives.

Dr. Ramo: [00:59:46] In the motivational psychology space, we've known for a while that how people think about and react to a failure situation influences so much about whether they'll try something again, whether they'll pick up after they've failed. A lot of interventions have been influential in helping people cultivate this idea that failure is not only the worst thing, but it's okay, it's healthy, it helps us grow.

Dr. Ramo: [01:00:21] The extent to which someone has a growth mindset, this belief that if something doesn't go well, it's because we didn't try hard enough, it helps us try harder the next time and come up with an eventual solution that will work in so many different aspects of our lives. In school settings, in work settings, in our social relationships, and even with partners. Having this idea that failure is not the worst thing is helpful for us psychologically in almost every aspect of our lives. We kind of know that on the behavioral science side.

Amberley: [01:00:58] Yeah, that makes perfect sense. If you make perfection off the bat your bar for success, you'll never succeed, period.

Dr. Ramo: [01:01:07] Couldn't agree more.

Amberley: [01:01:08] For sure. If you shift it to be, I guess make your goal the mindset or how you'll react to things, like you said, you called it a growth mindset. Make the bar learning, getting something out of it.

Amberley: [01:01:25] Cool, well I think that is about the time that we have. Was there anything else that you wanted to mention?

Dr. Ramo: [01:01:33] Just that if people want to hear more about what we're doing at Hopelab, please consider coming to AnxietyTech in New York on August 23rd, and feel free to check out our website to learn more about our solutions and our process at Hopelab. Thank you so much for the opportunity.

Amberley: [01:01:52] Really, really appreciate you taking the time to chat.

Kurt: [01:01:55] Yeah, absolutely. It was a pleasure having you.

Kurt: [01:02:05] Well, that's it for our first episode.

Amberley: [01:02:07] If you enjoyed the episode, we really hope you'll join us again next time. And, if you know someone who you think would enjoy the show too, we would love it if you would send it to them so they can check it out.

Kurt: [01:02:17] Also, if you're in the NYC area, we hope you'll check out AnxietyTech on August 23rd. The tickets are only $25 for students and $50 in general. If you'd love to go, but can't afford the ticket, DM us at fullstackhealth on Twitter. We'll give away tickets to the first four people to reach out.

Amberley: [01:02:36] Thanks again so much for joining us, and be well, everyone.