By THIRSTY
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.
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| HealthRhythms |
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.
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| 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.
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