Mind Ease: a promising new mental health intervention

by PeterBrietbart23rd Oct 20188 comments

14

Cause candidatesMental health
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What is Mind Ease?

We’ve developed an anxiety management tool called Mind Ease. Our intention is to make it the most effective tool in the world for quickly calming down whenever you are feeling stressed, anxious or tense. The aim is to grant you control over your anxiety symptoms whenever you need it (rather than being a tool for the long term treatment of anxiety disorders).

Whenever you feel stressed or anxious, you just open the app, and it selects a technique automatically to help you calm down in under 10 minutes. Over time, it learns what works for you, becoming better and better for you specifically, but we also learn from the data more generally in order to improve all the techniques for all users. Right now, the app uses 11 different techniques to calm you down, all of which we've demonstrated the efficacy of in our own randomized controlled trials. There are some specific implementations of familiar techniques included, such as meditations, CBT, and gratitude journaling; and some less well known exercises, such as progressive muscle relaxation and anxiety defusion.

What we envision is a world where people who suffer anxiety always have a reliable way to feel better whenever they need it. We want people to directly suffer less, have their lives less negatively affected by anxious-avoidance, and have greater control over their own mental states.

We are currently developing Mind Ease as a web app. Android and iOS versions are coming soon.

EA-relevance

Mental health as a promising EA cause area has been discussed a few times in the past couple of years.1 Neither GWWC nor GiveWell have many clear pointers for people who want to contribute in this space, perhaps due to the low perceived tractability of the problems involved. The large majority of the work done on mental health takes place in healthcare and academic research, which can make a person feel like all they can do is contribute a small drop in an ocean of other activity. GWWC suggested that one neglected area is discovering which interventions work best for different mental illnesses.2 And for anxiety, that’s what we’ve tried to do.

Does the world need this?

Yeah, a lot. Anxiety is the most common mental health disorder in the world,3 is a major predisposing factor for depression,4 is strongly negatively correlated with subjective wellbeing,5 impairs cognitive performance6 including everyday tasks and problem solving,7 and has been linked as a trigger for asthma, coronary heart disease, irritable bowel syndrome, ulcers, and inflammatory bowel disease among other conditions.8

The 2018 Clark et al. cost-effectiveness analysis of mental health and wellbeing estimates that, "Eliminating depression and anxiety would reduce misery by 20% while eliminating poverty would reduce it by 5%".9 Of course, these numbers are speculative, but even conservative estimates mark this as a problem worth solving.

Is this useful to me or people I know?

We believe it is, if you or people you know are anxiety sufferers. You can check out the Mind Ease splash page and beta app here – feel free to use it or share it with people who could benefit from anxiety relief, but keep in mind that we have numerous improvements planned and we're rapidly iterating. We'd love any feedback you have about how we can make it better.

 In particular it will be likely to help:

  • those who suffer from acute anxiety, or who struggle with anxious thoughts. Our data suggests that the higher a person’s GAD-7 score (i.e., the more they suffer from anxious symptoms), the better our interventions work.

  • those who have a predictably stressful life. Mind Ease really shines if you know you will be encountering sources of stress as part of a routine, as the short interventions allow you to pre-emptively defuse the negative feelings.

  • those who do not consider themselves anxious, but who often encounter anxious thoughts and feelings that reduce quality of life.

What interesting findings so far?

The big one is – based on an internally run study of 250 uses – Mind Ease reduces anxiety by 51% on average,10 and helps people feel better 80% of the time.11 We think this is extraordinarily good, and it's the result of testing a lot of different interventions in randomized controlled trials, and refining the techniques repeatedly.

In a separate study, we found that 70% of moderate/high-anxiety people (and also a surprising 37% of non/low anxiety people) are interested in using the app.12

In yet another study, we took a random sample of people (n = 303) recruited via Positly, gathered their GAD-7 score, and asked them, “do you identify as an anxious person?”. Commonly, a GAD-7 score of 5-9 represents “mild anxiety”, 10-14 “moderate”, and 15+ “severe”. We found that at scores of 5 and up, the vast majority of people (94%) consider themselves to be “an anxious person”. That’s 73% of all participants, i.e., if the study generalises, only 27% of people do not consider themselves to be an anxious person. 

How will we be able to compare this with other interventions?

It’s a good question, and the answers aren’t clear-cut. There have been a few attempts at evaluating mental health interventions in terms of comparable metrics, notably Elizabeth van Nostrand’s laudable work.13

The parts of the equation we need are:

  • Effectiveness in terms of QALYs/DALYs/LS/SWB. This is tricky as we use a custom evaluation scale that uses three 7-point likert scales measuring general affect, mental well-/ill-being and bodily well-/ill-being (measurements are taken before and after each intervention).

  • Additionally, we’d need counterfactual impact measurements. We don’t include a group that does no exercises but instead we run a control group who do a relatively boring “learning about anxiety” exercise that has no clinical justification/support. Interestingly, this exercise shows non-zero effectiveness, showing that regression to the mean is a likely explanation for some of the improvement that users see. Notably, in another study we conducted, 54% of ‘moderate’ and higher anxiety (GAD-7 scores of 10 and up) say they don’t have a reliable method to calm down when they need it.

  • Cost – also tricky, as it’s unclear how best to measure this. Ordinarily we’d want to use the cost of treatment, but the app is currently free. Once the app has a monthly fee in wealthy countries and reaches profitability, further benefits to users will essentially become free (as the cost to administering it becomes negative for us!).

One important thing we’re able to do is directly compare the effects of radically different anxiety-management interventions. In the academic psychology literature, unless two studies use very similar methodologies on very similar populations, comparing the results in terms of effectiveness is super difficult. Since all our exercises follow the same data measurement practices and methodology, we don’t have this generalisation problem to the same degree.

Who is working on this project?

The project is run by myself (Peter Brietbart) and supported by Spencer Greenberg. An extremely talented bunch are working on the app, including Mihai Badic, Peter Moorhead, Teis Rasmussen, and Elysia Segal. 

How can I help?

A few ways:

  • Send the beta version of Mind Ease to people who you think could plausibly benefit from it. The splash page with links to the app is at mindease.io. You can access the app directly at mindease.io/beta

  • Participate in discussions of mental health as an EA cause area. The facebook group Effective Altruism, Mental Health, and Happiness is a great place for it.

  • Try out the app and send me feedback. As I've mentioned, we're still in beta and iterating fast, so your feedback would be especially helpful right now. I’m peter@mindease.io

Thanks for reading!

 

 


References and footnotes:

1. Elizabeth Van Nostrand (2017). Mental Health Shallow Review. http://effective-altruism.com/ea/1ha/mental_health_shallow_review/

Michael Plant (2017). Is effective altruism overlooking human happiness and mental health? I argue it is. http://effective-altruism.com/ea/yv/is_effective_altruism_overlooking_human_happiness/

2. Konstantin Sietzy (2015). Mental Health Interventions May Be More Cost Effective Than We Think. https://www.givingwhatwecan.org/post/2015/12/mental-health-interventions-may-be-more-cost-effective/

3. Twenge J. M. (2000). The age of anxiety? Birth cohort change in anxiety and neuroticism, 1952–1993. Journal of Personality and Social Psychology, 79, 1007−1021. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.360.8349&rep=rep1&type=pdf

4. Bagby, Joffe, Parker, Kalemba, & Harkeness (1995). Personality Disorders and the Five-Factor Model of Personality. Journal of Personality Disorders: Vol. 9, No. 3, pp. 224-234. https://doi.org/10.1521/pedi.1995.9.3.224

5. DeNeve KM, Cooper H. (1998). The happy personality: a meta-analysis of 137 personality traits and subjective well-being. Psychological Bulletin Sep;124(2):197-229. https://www.ncbi.nlm.nih.gov/pubmed/9747186

6. Seipp B. (1991). Anxiety and academic performance: A meta-analysis of findings. Anxiety Research, 4(1), 27-41. http://dx.doi.org/10.1080/08917779108248762

7. Matthews G., Coyle K., Craig A. (1990). Multiple factors of cognitive failure and their relationships with stress vulnerability. J Psychopathol Behav Assess 12: 49. https://doi.org/10.1007/BF00960453

8. Edelmann, R. J. (1992). The Wiley series in clinical psychology. Anxiety: Theory, research and intervention in clinical and health psychology. Oxford, England: John Wiley.

9. Clark, Flèche, Layard, Powdthavee and Ward (2018). The Origins of Happiness. Princeton University Press. New York.

Also see: https://www.whatworkswellbeing.org/blog/origins-of-happiness-new-research/

10. This was from a paid pilot study on 49 people, run via Positly over the course of 5 days. The 51% average was computed by looking at interventions completed (not partial ones) and for people who had any negative feelings to start (based on any of our 3 likert scale questions having a negative value) we calculated the average % reduction in these negative feelings (which would be negative if a person's negative feelings increased).

11. Meaning that people's initially reported negative feelings are reduced by the end of the completed intervention.

12. Based on reading a description of the app and it's purpose. 

13. Elizabeth Van Nostrand (2017). Measuring the Impact of Mental Illness on Quality of Life. http://effective-altruism.com/ea/1he/measuring_the_impact_of_mental_illness_on_quality/

Elizabeth Van Nostrand (2017). Cost Effectiveness of Mindfulness Based Stress Reduction. http://effective-altruism.com/ea/1hx/cost_effectiveness_of_mindfulness_based_stress/

8 comments, sorted by Highlighting new comments since Today at 4:21 PM
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[based on an internally run study of 250 uses] Mind Ease reduces anxiety by 51% on average, and helps people feel better 80% of the time.

Extraordinary claims like this (and it's not the only one - e.g. "very likely" to help myself or people who I know who suffer from anxiety elsewhere in the post, "And for anxiety [discovering which interventions work best] is what we've done, '45% reduction in negative feelings' in the app itself) demands much fuller and more rigorous description and justification. e.g. (and cf. PICO):

  • (Population): How are you recruiting the users? Mturk? Positly? Convenience sample from sharing the link? Are they paid for participation? Are they 'people validated (somehow) as having an anxiety disorder' or (as I guess) 'people interested in reducing their anxiety/having something to help when they are particularly anxious?'
  • (Population): Are the "250 uses" 250 individuals each using Mindease once? If not, what's the distribution of duplicates?
  • (Intervention): Does "250 uses" include everyone who fired up the app, or only those who 'finished' the exercise (and presumably filled out the post-exposure assessment)?
  • (Comparator): Is this a pre-post result? Or is this vs. the sham control mentioned later? (If so, what is the effect size on the sham control?)
  • (Outcome): If pre-post, is the postexp assessment immediately subsequent to the intervention?
  • (Outcome): "reduces anxiety by 51%" on what metric? (Playing with the app suggests 5-level Likert scales?)
  • (Outcome): Ditto 'feels better' (measured how?)
  • (Outcome): Effect size (51% from what to what?) Inferential stats on the same (SE/CI, etc.)

There are also natural external validity worries. If (as I think it is) the objective is 'immediate symptomatic relief', results are inevitably confounded by anxiety a symptom that is often transient (or at least fluctuating in intensity), and one with high rates of placebo response. An app which does literally nothing but waits a couple of days before assessing (symptomatic) anxiety again will probably show great reductions in self-reported anxiety on pre-post, as people will be preferentially selected to use the app when feeling particularly anxious, and severity will tend to regress. This effect could apply to much shorter intervals (e.g. those required to perform a recommended exercise).

(Aside: An interesting validity test would be using GAD-7 for pre-post assessment. As all the items on GAD-7 are 'how often do you get X over the last 2 weeks', significant reduction in this metric immediately after the intervention should raise alarm).

In candour (and with regret) this write-up raises a lot of red flags to me. There is a large relevant literature which this post does not demonstrate command of. For example, there's a small hill of descriptive epidemiology papers on prevalence of anxiety as a symptom or anxiety disorders - including large population samples for GAD-7, which would look better routes to prevalence estimates than conducting a 300-person survey (and if you do run this survey, finding a prevalence in your sample of 73% >5 GAD given the population studies (e.g.) give means and medians ~2-3 and proportions >5 ~ 25% prompt obvious questions).

Likewise there are well-understood pitfalls in conducting research (some them particularly acute for intervention studies, and even moreso in intervention studies on mental health), which the 'marketing copy' style presentation (heavy on exuberant confidence, light on how this is substantiated) gives little reassurance they were in fact avoided. I appreciate "writing for an interested lay audience" (i.e. this one) demands a different style than writing to cater to academic scepticism. Yet the latter should be satisfied (either here or in a linked write-up), especially when attempting pioneering work in this area and claiming "extraordinarily good" results. We'd be cautious in accepting this from outside sources - we should mete out similar measure to projects developed 'in house'.

I hope subsequent work proves my worries unfounded.

Hey Gregory,

Thanks for the in-depth response.

As I'm sure you are aware, this post had the goal of making people in the EA community aware of what we are working on, and why we are working on it, rather than attempting to provide rigorous proof of the effectiveness of our interventions.

One important thing to note is that we’re not aiming to treat long-term anxiety, but rather to treat the acute symptoms of anxiety to help people feel better quickly at moments when they need it. We measure anxiety immediately before the intervention, then the intervention runs, then we measure anxiety again (using three likert scale questions asked both immediately before and immediately after the intervention). At this point we have run studies testing many techniques for quickly reducing acute anxiety, so we know that some work much better than others.

I’ve updated the post with some edits and extra footnotes in response to your feedback, and here are some point by point responses:

How are you recruiting the users? Mturk? Positly?

We recruit paid participants for our studies via Positly.com (which pulls from Mechanical Turk automatically applying extra quality measures and providing us with extra researcher focussed features). Depending on the goals for a study we sometimes recruit broadly (from anyone who wants to participate), and other times specifically seek to recruit people with high levels of anxiety.

Are the "250 uses" 250 individuals each using Mindease once? If not, what's the distribution of duplicates?

This data is from 49 paid study participants who used the app about 5 times total on average over a period of about 5 days (at whatever times they choose).

This particular study targeted users who experience at least some anxiety.

Does "250 uses" include everyone who fired up the app, or only those who 'finished' the exercise (and presumably filled out the post-exposure assessment)?

It's based on only the people completed an intervention (i.e. where we had a pre and post measurement).

Is this a pre-post result? Or is this vs. the sham control mentioned later? (If so, what is the effect size on the sham control?)

This is a pre-post result. In one of our earlier studies we found the effectiveness of the interventions to be about 2x - 2.5x that of the control (13-17 "points" of pre-post mood change versus about 7 for the control). We've changed a lot about our methodology and interventions though, and don't have measurements for the control yet with the new changes.

If pre-post, is the postexp assessment immediately subsequent to the intervention?

Yes. Our goal is to have the user be much calmer by the time they finish the intervention than they were when they started.

"reduces anxiety by 51%" on what metric? (Playing with the app suggests 5-level Likert scales?)

Using the negative feelings (not any positive feelings) reported on 3 likert scale questions. So people who reported no negative feelings at the beginning of the intervention are ignored for analysis since there are no negative feelings reported that we could remove.

Ditto 'feels better' (measured how?)

The 80% success rate refers to whenever a user’s negative feelings are reduced by any amount.

And thank you for telling me your honest reaction, your feedback has helped improve the post.

Just a few comments on the website:

  • Clicking on the "Feel better. Fast", "Science-based", or "Free & easy to use" link to a "/undefined" page, which leads to a 404 error.
  • The "Science" link the navigation bar scrolls down to "See how you're doing, develop over time", which isn't really about science.

Overall, claiming being "scientifically proven" without references to actual studies and the use of first name–only testimonials pattern-matches to the sample pseudoscientific websites that my Psych 101 textbook presents. If I had not read this post, I would be quite hesitant to try out the app. I think it would be helpful to have a page about the scientific support for meditation, progressive muscle relaxation, etc., and Mind Ease itself as you did here. It might be difficult to have quotes that are less anonymous (e.g., by providing their full name, photo, and occupation), given the stigma surrounding anxiety, but if it's feasible, I think it would increase the credibility.

Looks really cool!

I'd be interested to hear why something like this has not been developed already and why you (presumably) expect that it would not have been developed in the near future by non-EAs.

It seems to me like the model could be profitable. Also, consumers should be able to differentiate products within the market and thus pick more effective ones which should incentivize increased effectiveness for anxiety-focused apps.

Might there be some kind of perverse incentives that most companies have in this sector? Or is this just an overlooked opportunity?

+1 to being curious about how this differs from Pacifica

I was about to say - this seems similar to the Pacifica app. My guess is that you may have a more evidence-based approach than most app builders?

hey there,

it seems to me, that there is a lot of confusion about anxiety as a (recurrent) short-symptom (which your app is targeting) and anxiety as a mental health disorder (coded via icd-10 or dsm-v). you are citing papers about anxiety as health disorders to proof that there is a huge need for targeting anxiety symptoms. sure there is an overlap, but still: that does not fit. (or am i wrong?) i am not even sure, if it´s a good way to use this tool against anxiety symptoms. taking a pain pill against each small short-term feeling of pain would (in the long run) weaken my ability to deal with pain without a pill. the same is true for anxieties or phobias. maybe the same is true for this app (maybe except for the technique of defusion). but maybe people simply learn some techniques and then they won´t need the app anymore... that´d be great! i hope i am wrong about my concerns (and that happens a lot!), and good luck with the app!

Neat! Where can we sign up to be notified of the iOS and Android versions?