How Technology Can Help Deliver Crucial Mental Health Support

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Thomas Bailey:
Welcome to Pursuing the Public Good, a podcast that brings you stories of how work in higher education can make impacts and build connections beyond the walls of our institution. I'm Thomas Bailey, President of Teachers College, Columbia University, and I'll be your host. This week, we're talking about mental health. It's a topic that I think is so crucial for a number of reasons, not the least of which is what has been described as growing crisis in the United States and around the world. New York's Governor Kathy Hochul focused on mental health challenges facing children and teens in her recent state of the state address, calling out the impact of social media in particular. This week's guest is Douglas Mennin, Professor of Clinical Psychology and Director of Clinical Training here at Teachers College. Professor Mennin's work focuses among other things on emotion regulation therapy for anxiety and mood disorders. It's an intervention strategy really. Recently, he and colleagues have begun exciting work on the role of technology in this area. Hello, Doug. Welcome and thank you for being here.

Douglas Mennin:
Thanks so much for having me. It's great to be here.

Thomas Bailey:
I know that there are many important areas of focus that you and your colleagues are working on in the field of mental health, but this week we want to dive deeper on just one piece of what you're doing, integrating technology into mental health support. Before we get there, tell us what area of mental health treatment you're focusing on and why we might have a need for better interventions.

Douglas Mennin:
Yeah, absolutely. We know these are really uncertain times and many people are impacted by that uncertainty because of people losing their job, of unrest, of difficulties in one's community. People also are increasing in having anxiety, mood conditions, trauma, and all those experiences produce a sense of uncertainty of not knowing what could come next. And that can be a state of apprehension of chronic stress. When stressors are uncertain and are daily, we can get into a state of apprehension. We might have loss, and those can produce anxiety and mood conditions. We treat people who have diagnosable anxiety and mood conditions and we treat people who are in difficult scenarios, people who have medical conditions, people who have loved ones with medical conditions, and also people who went through the pandemic and had some difficult experiences through the pandemic and are impacted by COVID. So those are some examples of people who are experiencing what we call distress, just the experience of stress that we keep in our minds.

Thomas Bailey:
I guess COVID is one thing, but you think those are increasing, that in general we're having more of that?

Douglas Mennin:
We are. There's more uncertainty. I think there's less sense of community. There are more economic uncertainties, more experiences of discrimination and bias. There's more pressure with less opportunities. So I think young people particularly have more pressures on them. Of course, I'm sure we'll talk more about the pros and cons of digital experiences, but the online community also challenges people in ways that we've never experienced before. There's some research that shows that there really is a cohort effect. When I say cohort, what I mean is we're thinking of people this age. We're also looking at it within this generation, within this time period. We might compare this cohort to young people who are in their 20s and 30s say, or teens and 20s to those in the 1980s or those in the 1940s. We think of what was happening for the same age group in different times, and we talk about that. Certainly other past cohorts had to deal with things like World War and other things, but the evidence shows there's more anxiety in this cohort. There's just generally more uncertainty.

Thomas Bailey:
Do we see a kind of a recovery from COVID a bit or?

Douglas Mennin:
People are improving and I think one of the big parts of this is social connection. So people coming back out and being able to reconnect with the parts of their lives, their roles, things that were there before. People have engaged with technology and remote work that have been useful and given people flexibilities, people also just learned to cope and learned that they have resiliency in ways they might not have realized before.

Thomas Bailey:
So you talk about the cohort effect. I mean, COVID is obviously one thing, but what are the underlying issues that make this cohort unusual or have its own characteristics?

Douglas Mennin:
One of the biggest parts is loss of community, at least in America. So not having a defined community or defined expectations. Those are all pros and cons. People have more flexibility and more say, but also have lost a sense of what to expect, economic changes, what people might think would lead to a successful life has changed. For many, there's less roads to success and I think there's more awareness of other people who may be gaining things that one isn't. The internet comes in that way too, so people have contrast and I think those things are a big part of it.

Thomas Bailey:
Tell us a bit about what it is that you're actually doing here to try to address these problems.

Douglas Mennin:
One of the most important aspects of managing distress is learning how to know when you're having it in difficult moments. Our work is really about helping people understand the parts of their emotional experience when they're in distress. We all know that we get upset, but we often have trouble catching or becoming aware of ourselves in those moments. We can feel cloudy, we can not have a sense of what to do, feel frozen. And what we know is we can draw from the science of emotions and the neuroscience of emotions. We know a lot about the stages of our mind in those very quick emotional experiences or over longer periods for the day or through weeks. And we can leverage that understanding of the brain, the body, the persons in social interaction to improve and help people respond to their emotions in difficult moments. So our work has been to delineate what skills would help people identify when they're in those moments, gain clarity in them and utilize different skills to get better at taking action.
And so our work has been to help people with very specific behavioral interventions that could help them make different choices and utilize skills to help them do that, to feel better, but also to be more effective. We're very interested in making sure what we say we're doing is what we're doing. So we examine a number of different indices of subjectively, behaviorally, biologically immunologically to see are those things really changing and do people get better in the ways that we'd expect and is it because of the things we're doing? So we're really interested in isolating those interventions for those kind of moments. That offers an opportunity to really look at how do you reach people in moments? How do you get people to do something different? Habit change is very hard, we know, and that's really where technology comes in and that's where a lot of our work has been headed.

Thomas Bailey:
Can you say something specifically about how that works and what happens when that process is taking place?

Douglas Mennin:
Absolutely. We dove most into this during the pandemic. It was out of necessity. We were running a large trial involving treatment and neuroimaging and then everyone had to shelter in, and we also wanted to help people who are under distress, especially from communities that often don't get reached. So we first developed a system of just doing remote therapy, video therapy, but trying to have them utilize a system that they could use when they weren't talking with someone. So we developed an app and really want to have a shout-out to my PhD and master's students from TC who were such instrumental part of developing this during a very difficult time to help reach people.

Thomas Bailey:
One of the images of the mental health crisis is people staring at their phones and disconnecting. So when you think about counseling and therapy, doing it through a phone almost seems like a contradiction. How do you deal with the issue of too much social media, too much staring at a device at the same time using that to address some of those same problems?

Douglas Mennin:
I think it's the idea like when you have an icy road and you turn into the skid instead of away from it. We're not going to go back to a different time where it's not here. The question is how we use it? The quality of how people engage technology matters, and when people engage technology in a more healthy way, it often spurs them to other types of action that are outside technology. It meets them where they are and allows you to reach them at those points. Also, we have to think about it differently. Even when we think about therapy, a lot of people think, well, I don't want to talk to someone on video. I want to see someone in person. But there's different forms of intimacy. There's different ways that when we think even about teaching that Zoom and doing remote work creates a different way of learning.
Being able to connect with someone on a phone or on a video provides a certain kind of eyes on connection that isn't necessarily there. When we're speaking in person, we might look away. So there are ways to actually create intimacy even with texting, that can actually be more intimate, especially for younger generations to be able to express themselves. So there are ways that you can get people to go do things outside to put their phone down, but reaching them from the phone might be a more powerful way to do that than ask them to put down the phone first.

Thomas Bailey:
So how does somebody get access to this? Is it through a therapist or can I download it from the app store?

Douglas Mennin:
Not yet, but for this system, we're still testing it. And so for those interested in being involved in the study, they would be people who meet criteria for having difficulty with anxiety and mood problems, that being distressed either chronically or from a difficult experience. We would then speak with them. We would then send them some questionnaires to see if they meet that criteria, and if they do, we then speak to them more about their experiences. They would come in and once someone is consented into the study and they're going to be a participant, they'll be given a Fitbit watch, they'll be given applications they can put on any of their devices. We are going to then measure movement and activity, gyroscopics. We're going to be measuring heart rate and their conductance of their skin to get their general arousal. And we'll be looking with consent from the participant feedback from their usage of their phone, things they might be writing, different words they would use, how much they move the phone, what applications they use.
All of that is para data that we may examine. That information is utilized to then send a signal to our system and based on certain types of algorithms, we can then send back a message to their app that they're using that they may be in need of the skills that we have to provide. They would then see within their feed this opportunity to utilize this quick intervention. They would consent to it and then it'll be offered. For instance, when the system might detect that and individuals in need, it will then call up a corresponding intervention that could be useful. Something like a breathing technique or for an individual who may be having thoughts of wanting to hurt themselves, a set of perspectives they could take that might be useful to see things differently or gain social support or take an action to reach out to a friend. Things like that, that are short and small, but we know are crucial in moments of distress.

Thomas Bailey:
So I'm going through the day, I'm anxious, I'm depressed about something, my mood is changing. One of the things you're saying is that the technology might identify that, but what if I feel that way? I mean, can I pick up my phone and experience some of these therapeutic activities just like that?

Douglas Mennin:
Absolutely. In the app, you can go and choose what you need from what you've learned. You also can just hit a help button, I need help, and then the system can come up and bring you to that. And then there are a set of techniques that they've learned that they can utilize.

Thomas Bailey:
All right, so can you tell us what sets this apart? Tell us about how this differs from what other people are doing in other approaches.

Douglas Mennin:
I think Teachers College is a unique environment because we really hit many foci, right? We're able to contact the clinic that those in need, we're able to contact those in school and learning environments also in communities in need, as we hear in New York, we span so many different areas. So that offers a lot of expertise and a lot of ways that TC researchers are able to think a little bit outside the box. When I think about the pandemic study that we did, the trial, we were able to reach communities in need.
We were able to think about ways that the technology could meet people's experiences here in New York. Some people were sheltered in, we had people respond on their phones and they could join us from a park. There are ways that we could be more flexible and creative, and I think that has to do with being in New York. We also could collaborate with different types of academics that allow us to sort of think outside the box. We also get a chance to use Ph.D. and math students that have an understanding of both clinical experiences, research, education, and that allows us to think differently about how we reach people. The young people in school and our students were such a big part of how we were going to do our work.

Thomas Bailey:
So well actually that ties into our next question, which is how can this work tie in with schooling and how can the use of technology be used in K-12 for these things? I mean, I know you tend to have somewhat older folks in this process, but nevertheless, how can we kind of extend that and think about how that can be useful in K-12?

Douglas Mennin:
Absolutely. Well first, I mean some of it starts at home and we saw that during the pandemic where parents were becoming home educators. It's the same thing in the sense of how to get parents more involved in the educational process. Technology allows connectivity from the school to the student, to the home experience. It encourages a form of learning that can happen both at home and in school. It also involves teachers being able to reach their students. I think particularly around emotional difficulties, the schools are often the front lines of where students are struggling. Being able to utilize systems that teachers connect to students, parents can connect to those students, parents connect to teachers creates a communication form, especially around students that might be in need or might be having a difficult experience. We know that programs that have taught emotional abilities and mindfulness to kids have been very helpful within school systems, especially when they're integrated within curricular plans. And technology has been a big part of that because you have so many of the people involved utilizing a common language.

Thomas Bailey:
Say a little bit about how you do or you could potentially connect with our teacher preparation programs with our professors who are preparing teachers to strengthen what they're doing.

Douglas Mennin:
One of the things that I think of right away is teacher-instructor stress. There's a lot placed on teachers in K-12. Certainly there are ways that those teachers talk to each other and learn to support each other. But I think with technology, it allows teachers to speak to each other and reach each other during those difficult times. Those moments of distress and being able to speak with each other and be able to note those times and have a common method of responding to them can be very useful. Similarly for students learning a common system of responding to difficult emotions and being able to talk to each other about that, to be able to message each other, mention that's going on, kind of like a slack for support, I think are ways that technology can help some of the emotional difficulties that happen.

Thomas Bailey:
So this is something that teachers and caregivers can use for themselves to allow them to better serve the students and the people they're taking care of.

Douglas Mennin:
Exactly. Exactly.

Thomas Bailey:
So is this the kind of thing that we could incorporate into our own instruction and our own courses so that people would have these types of skills for themselves, but also as we've said, so they would be better able to serve the students or other people they're working with?

Douglas Mennin:
Absolutely. Everything I'm talking about sounds very individually oriented and certainly it always comes back to one's own actions, but these all exist in systems and here at TC we are a system and we'll all operate better if we can improve our overall health and wellbeing. If those systems are available that people could share those commonalities and be able to respond in moments, then it will improve our general understanding of what are the things that we need to make better, what are the ways that we can improve the system and work together in different areas? It provides a sort of communication with oneself, but also with others around common pitfalls.

Thomas Bailey:
So I know that generally you do 18 years and older. We talked before about how this can get into the classroom basically by way of the teachers and the caregivers, but have you thought about direct use of this by adolescents?

Douglas Mennin:
That's our next stage right now, we're talking with collaborators and colleagues about adapting the system to adolescents. For each new population we work with, we want to adapt it properly. Learning about that population or that problem and making changes to the treatment that match the population we're working with, we're doing that right now, and so we're excited about where that would go.

Thomas Bailey:
That's one way of scaling this. Are there other ways, just in terms of the availability of the technology and the approaches that you have?

Douglas Mennin:
There are different ways that scaling is starting to be done. One of those is trying to get out into... Again, it's those systems where young people are, things like TikTok and Instagram and creating scalable interventions. They're not meant to fix everything and they're not meant to keep people on their phones, but they're meant to reach people when they're in a difficult moment. So using those same kind of analytics, these systems would reach people when they see certain words that are said that might be concerning, certain places, they may be going on apps and like the way we get annoying ads be given a possibility to do a very brief intervention that may help people engage.

Thomas Bailey:
So we're an academic institution here. We do research. So what evidence do you have that this works?

Douglas Mennin:
Everything we do is science-based. So everything that we're talking about, we've tested. Some of the things we're in process of testing. So it really starts with what are you giving or what the tools you're giving them actually substantiate through science. And that's a form of discovery science, and that's where a lot of our work has been. It's been saying, does this intervention actually help the people that we are trying to help and does it work for the reasons we say it does? That's essentially important.
Because there are many apps that can help people. They do. It's not that they don't, but they may not be substantiated by science. They may not help everybody the same way. As scientists we want to make sure that these things work, and that's something that we first do. So then you want to make sure that it's able to reach people. But we're testing how to really have a system that does reach people reliably. We don't want to bother them when they don't want to be bothered. We want to make sure that we're capturing a moment that could be helpful. So all that takes science and understanding, and we're in the midst of that right now.

Thomas Bailey:
So you're doing clinical trials and other kinds of things.

Douglas Mennin:
Exactly.

Thomas Bailey:
I'm sure that issues around improving mental health care are relevant to many of our listeners and their loved ones. So what would you say people should take away from the work that you're doing or look for as they care for themselves and for their families?

Douglas Mennin:
It's a great question. People often feel some matter of hopelessness or that nothing can change. Understanding that small changes matter. Even something as mundane and simple as breathing, taking a moment to breathe can be very powerful. Stepping back and getting a sense of oneself, even journaling, exercise. So many of the interventions that we have are useful and can make a lot of change in a smaller amount of time, even in really difficult situations. So when people think, what's that going to do, that's part of what we're doing when we reach people in the moment, is showing them that one little thing can make a big difference if practiced over time.

Thomas Bailey:
This sounds great and there's so many good things about it. It allows people to use this without major investments. It's scalable, it's been shown to be effective. Here we are at Teachers College. What can we do as an institution to help you bring its benefits farther into the world?

Douglas Mennin:
One of the things that we know is technology moves very quickly, and as technology improves, so are the opportunities to be able to reach people and help people. So the more technological support we have, the more support we have in knowing what to do with complex data and be able to translate that into usable science. So creating a digital health support, particularly for research and our clinical offerings would be very helpful across the board, across the departments. It also would bring researchers, investigators together across TC who might not realize that they have a lot to say to each other. So I think a presence that lives beyond each program or department that is really about promoting digital health, both mental and physical.

Thomas Bailey:
Well, this is I think what we're trying to do with this public goods initiative. One of the things just in doing these podcasts myself, how many things I've learned about what we're doing. So I think that's certainly one contribution that we can make just within our own community to understand the things that people are doing. And as I've tried to emphasize the benefits of having both education and psychology and health together so that we can actually make real the promise of interdisciplinary work that we've all been talking about all of our careers, but as often lip service. So I really see within this, the way they're bringing these together, and I hope that we can go beyond the many individual things that faculty are already doing, all of which are wonderful, but pull them together in a way that makes people more aware of them, that gives them more power, that projects them more into the world. So I think this fits really well with that. Professor Mennin, thanks so much for joining us.

Douglas Mennin:
Thanks for having me. This has been very fun.

Thomas Bailey:
Thanks for joining us for this episode of Pursuing the Public Good. Next week, join us when we talk with Professor Oren Pizmony-Levy about how we can start taking actions now on one of the biggest challenges of our time, sustainability and climate change.
Pursuing the Public Good is produced by the Office of the President, the Digital Futures Institute, and the Office of Institutional Advancement at Teachers College, Columbia University. Take a look at our show notes for links to learn more about the work of our guests and the public good initiative at Teachers College, access transcripts, and see our full credits for this episode.