Depression is a disease that has the potential to ravage the personal and professional lives of the estimated 350 million people around the world who suffer from it each year. It affects nearly five percent of the US population (15.7 million people) and costs our economy $210 billion each year in healthcare costs and lost productivity. The disease doesn’t discriminate— it impacts both genders, people of all ethnicities, income-levels and careers. It can ruin relationships, careers and can even lead to death in some cases.
And yet, unlike many other diseases with similar impacts, medical treatment is extremely effective in treating many cases of depression. Therapy, medicines or some combination of both can significantly decrease or completely eliminate symptoms for those who suffer from the disease.
But even though these effective treatments exist, somewhere between 50 and 75 percent of those who suffer from depression cannot obtain access to treatment or do not seek it.
Overcoming these barriers and treating more sufferers has long been a goal of psychologists and psychiatrists. But budget cuts and limited time and resources have made it difficult.
Perhaps that’s why a free app born at Duke University and called MoodTools has taken off so quickly. It's earned a following and praise from both sufferers of depression and those trained to treat it because it's design is rooted in some of the most effective psychological theories and practices developed to date. With more than 200,000 downloads in two years, it helps users determine if their symptoms are indeed related to depression, reduce those symptoms, and find local help.
While students at Duke, recent grads Eddie Liu and Nancy Su designed the technology solution to help reduce the barriers preventing those who need treatment from seeking it. They don’t work full-time on the project and have a very limited revenue stream with no intentions of fundraising to support their work. Instead, the app is almost entirely a labor of love, built out of their genuine desire to help those who suffer from depression. Here's their story:
Developing the Tools
Liu grew up around science in Chapel Hill—his father is a professor in Duke’s chemistry department. But he became especially intrigued by psychology while taking a class taught by Lindy Krzyzewski Frasher (Coach K’s daughter) at his high school, the Durham Academy. As he relayed information he learned in his class to friends, they noticed his knack for understanding the human mind and began approaching him for advice, almost treating him as a stand-in therapist.
Liu’s early interest in psychology only increased with time—he eventually focused on psychology and neuroscience as an undergrad at Duke and is now studying at the UNC School of Medicine to become a clinical psychiatrist.
In the summer of 2014, Liu was studying for the MCATs—the SAT-like test for medical school applicants—and decided he’d work on his own project over summer break rather than seeking an internship or job at the local coffee shop. After some initial research, Liu found few online tools dedicated to helping people overcome depression and became determined to build something that would expand the availability of tested, proven psychological treatments for depression.
He chose to build an app as the delivery mechanism in part because he had long been interested in computer science, but also because it seemed a natural solution. He told me, “Therapy has proven to be really effective but only a minority of patients go into therapy…but giving basic information about therapy through a smartphone app is inherently infinitely scalable and can reach a big number of people.”
Liu quickly set to work teaching himself to code and brought in help from friend and fellow psychology student, Nancy Su. Su worked to translate psychological theory and practice into a user experience while Liu built the app. They also consulted with subject matter experts like Dr. Timothy Strauman, a professor of psychology and neuroscience at Duke University and expert in depression and translational research, who is using his scientific research to develop new treatments. Strauman helped the pair organize and identify technical resources on the treatment methods the app is based upon.
The end result was a group of six tools based on theories found in Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy—two of the most effective therapies used by doctors and counselors to treat their patients' depression. The tools were designed to be used in conjunction with one another, and are thus more likely to be effective when used together, but they are also available for download individually.
The six tools include:
- An information section on depression symptoms, types, causes and available treatments.
- A self-administered test that helps a user determine his or her level of depression
- Informational videos.
- A thought diary where users can track their emotions, distress levels and counter negative thoughts with positive ones.
- An activity tracker where users can track their activity and mood before and after the activity.
- A safety plan creation tool.
The tools aren’t revolutionary—they’re found in psychology literature and in the offices of psychologists across the world. But providing them to the masses free and through a mobile app allows for anyone, anywhere to access treatment and coping strategies previously only available to few.
Improving access to psychological services is important because up to 75 percent of those suffering with depression don’t seek treatment. The reasons are unique to the individual, but some common barriers are the cost of the services, stigma and a misunderstanding of the disease or the symptoms one is encountering.
The app is designed not to replace traditional therapy, but to reduce the barriers to seeking it and augment skills learned in official sessions with a place to practice them in the real world. And after years of sustained budget cuts to mental health providers and an ever changing healthcare and insurance industry, equipping practitioners with an additional treatment tool could increase their impact.
Liu says he’s only received positive feedback from the medical community and Strauman says he’s even advised clients to use the app. But Liu’s favorite feedback has come from the 200,000 plus users who on average have rated the app with 4.5 (out of five) stars. Over 400 users have also left overwhelmingly positive public written reviews, which Liu notes is “pretty brave of them.”