Ellen Frank, Ph.D. is Distinguished Professor Emeritus of Psychiatry at the University of Pittsburgh School of Medicine and former Director of the Depression and Manic Depression Prevention Program at Western Psychiatric Institute and Clinic. A world expert in mood disorders and their treatment, she served as Chair of the U.S. Food and Drug Administration Psychopharmacologic Drugs Advisory Panel from 1994-1996 and as a member of the U.S. National Advisory Mental Health Council from 1997-2001. She was elected to the National Academy of Medicine in 1999. Dr. Frank has published over 450 peer-reviewed papers in journals in psychiatry, psychology and medicine, as well as over 100 books and book chapters.

In 2014, she was part of the group that founded HealthRhythms, a high-tech company dedicated to “making it easier to measure and improve mental health.” In 2019, she became the company’s CEO in order to guide its development and implementation of technology for the monitoring of behavioral biomarkers of psychiatric illness and for the building of digital intervention platforms.

Stay Thirsty Magazine was honored to visit with Dr. Frank at her home in Park City, Utah, for these Five Questions about her mission to change the paradigm of how mental health can be improved though technology.

STAY THIRSTY: What is the genesis of your involvement in the development of apps to regulate better mental health?

ELLEN FRANK: How I got there is one of those beautiful accidents of fate. In 2012, Dr. Mark Matthews, a mobile app designer from Dublin, Ireland, came to Cornell University on a three-year fellowship from the European Union. His goal was to work in Dr. Tanzeem Choudhury’s People-Aware Computing Lab to develop technology for individuals with bipolar disorder. It took Matthews about three weeks in the United States to find me. As it happened, I had had ideas for years about how to use smartphones to help those with bipolar disorder, but I had no luck in finding the funding or the right collaborators to develop the product I had in mind.

Within a month, Drs. Choudhury, Matthews and I were off to the races, each bringing a unique skill set to this ambitious project. Within a year, we had developed an app called MoodRhythm, based largely on an approach to psychotherapy for bipolar disorder that I had developed and tested with my colleagues at Pittsburgh. Within another year, MoodRhythm had won a $100,000 competition for new health technology and we took that prize money to bootstrap the founding of HealthRhythms, a company that wants to put the help that people with mental disorders need right there in their hands, 24 hours a day, seven days a week.


STAY THIRSTY: As a world expert in mood disorders, what exactly did you, as a clinician, expect the technology that HealthRhythms was developing would do? How would it be different from the other apps currently in the marketplace?

ELLEN FRANK: To date HealthRhythms’ digital intervention platform has focused on patients with depression and anxiety, but the platform is now being adapted to a range of other mental disorders. What sets HealthRhythms’ approach apart from virtually all other online treatment products is that it capitalizes on the sensors available on every commercial smartphone (GPS, accelerometer, screen status, etc.) to create a highly individualized profile of each user’s behavior: When is she going to bed? When is she getting up? Is her sleep sound or disrupted? When is she leaving home for the day? When is she coming back? How much time is she spending at home altogether? How far is she traveling from home each day? How much exercise is she getting? And when? How much time is she spending on her phone?

Then that digital profile, coupled with very brief self-reported ratings of mood, is used to generate equally individualized suggestions for behavior change. And those suggestions appear right on the user’s phone at the right time of day. The doctor is literally right there in the user’s hand. And this doctor knows so much more about what is happening in patients’ lives, essentially all day, every day; more than has ever been possible with just typical clinic visits. And that’s a huge benefit in knowing what might be helpful to any individual patient.

STAY THIRSTY: How is this technology informed by your scientific work on the importance and consequences of sleep to a person’s mental health?

ELLEN FRANK: Because the central premise of HealthRhythms’ approach to intervention is that regular timing of routines is good for our health and our mood, a depressed patient with an erratic sleep/wake schedule might receive a suggestion like:

Hi Dani, Seems like most things are still bouncing around for you: your bed time, wake time, time at home, activity level and your mood. One thing that might get all of them to settle down is to go outside and look toward (but not right at) the sun for about 2 minutes as the sun is coming up – that's around 7am in your area right now. If you can keep it up for a week or more, that early morning sunlight tends to set all your body clocks for the rest of the day and improve your mood. Would you be willing to give that a try this week?

A patient whose data suggests he’s spending almost all his time at home and on his phone, would likely see a message like this one pop up on his phone:

Hi John, I can see that you’re hardly getting out these days and you’re surfing the net most of the time. Spending time with people you like can have a big anti-depressant effect if you can just push yourself to do it. What would you think about making a date to meet a friend for coffee at least twice this week?

At Pitt, I developed and tested a treatment for patients with bipolar disorder called Interpersonal and Social Rhythm Therapy (IPSRT) and I get almost daily queries seeking therapists trained in IPSRT in cities all over the United States and abroad, but such therapists are few and far between. How wonderful it would be to put a digital version of IPSRT into the hands of a patient in a remote town in Montana or in a small village outside Manchester, England.

STAY THIRSTY: With so much technology already available to the public, how do you see a path for the broad adoption of your technology?

ELLEN FRANK: Over our first few years in business, my company explored a number of different business models, including working with accountable care organizations, health insurance providers and other scenarios. We came to the conclusion that the best way to proceed was to work with pharmaceutical companies that have medications specific to the mental disorders we are focused on. So, a pharmaceutical company that has a medication for bipolar disorder might be interested in marketing a product like MoodRhythm in combination with their drug as a way of enhancing the attractiveness of their drug, improving outcomes for patients who are prescribed their drug and increasing adherence to the total treatment program. Another company that is testing a new medication for autism spectrum might see advantages to providing a pair of complementary, coordinated digital intervention platforms for the child in question and his caregivers.

This approach to dissemination of our technology has two major advantages: first, it’s consistent with the overwhelming evidence that for most psychiatric disorders, outcomes are significantly improved when the right medication is combined with a disorder-specific psychosocial or behavioral treatment approach; and second, this approach enables a small company like HealthRhythms to capitalize on the enormous reach of pharmaceutical companies in terms of getting interventions to clinicians and, in turn, to patients.

Ellen Frank, Ph.D.

STAY THIRSTY: After a distinguished career as a professor, scientist and clinician, what is it about this new technology that has ignited your passion to begin a second career?

ELLEN FRANK: Do you mean what keeps me working 50+ hours a week when I could be out on the slopes of Park City, Utah, where my husband, Dr. David Kupfer, and I are living since retiring from Pitt? Simply the idea that this type of positive mental health intervention could reach hundreds of thousands of patients, maybe even millions. That's the promise of digital intervention technology.


All opinions expressed are solely those of its author and do not reflect the opinions of Stay Thirsty Media, Inc.