Psychedelics & Digital Phenotyping
Software-Assisted Psychedelic-Assisted Psychotherapy: Part 3/n
We've been exploring the interface of psychedelics and technology lately because my vision of the future has been cracked open since digging into the field of Digital Therapeutics a few weeks ago.
As we noted in Software-Assisted Psychedelic-Assisted Psychotherapy: Part 1, the field made a significant step with the FDA's approval of a video game for ADHD:
“The FDA approved the first video game for the treatment of ADHD developed by Boston based Akili.
“The U.S. Food and Drug Administration (FDA) has granted clearance for EndeavorRx as a prescription treatment for children with attention-deficit/hyperactivity disorder (ADHD). Delivered through a captivating video game experience, EndeavorRx is indicated to improve attention function as measured by computer-based testing in children ages 8-12 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue”
Telemedicine, coaching, and apps that leverage reward and incentives to promote healthy lifestyle choices and behavior change have been the dominant mode of consumer technology in the service of medical endpoints.
I have been thinking of these tools as Digital Therapeutics 1.0—this capability is already in use in psychiatry, psychology, and mental health delivery and will continue to grow.
This kind of technology and its use are at the heart of the delivery, affordability, and access issues in the emerging psychedelic-assisted therapy field.
Where things get interesting is in the next phase of Digital Therapeutics, aka DTx 2.0.
Particularly two modes:
Software as a Drug
Akili's video game for ADHD is an example of Software as a drug. I imagine that when Introspect CEO David Keene talks about the magnification of the psychedelic effect, it will come from this type of technology.
From Harvard's Digital Phenotyping and Beiwe Research website:
““What is digital phenotyping?” We define digital phenotyping as the “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices, in particular smartphones.”
The critical takeaway is that Digital Phenotyping relies only on gathering data from regular interactions one has with their phone, such as swiping, typing, scrolling, speaking, etc. NOT the "active" answering survey questions or responding to prompts throughout the day.
From an article in Nature titled Toward clinical digital Phenotyping: a timely opportunity to consider purpose, quality, and safety:
"The use of data generated passively by personal electronic devices, such as smartphones, to measure human function in health and disease has generated significant research interest. Particularly in psychiatry, objective, continuous quantitation using patients’ own devices may result in clinically useful markers that can be used to refine diagnostic processes, tailor treatment choices, improve condition monitoring for actionable outcomes, such as early signs of relapse, and develop new intervention models." (emphasis added)
Digital Phenotyping> Subjective Surveys
Digital Phenotyping promises that it will solve the problem of quantifying subjective conditions that have no objective markers—the kind of conditions that psychedelic medicine is most interested in treating.
Depression, PTSD, Addiction have no viral loads; there are no confirmatory blood tests; there is no objective diagnosis.
For example, for the Phase III trial of PTSD, MAPS uses the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), an interview conducted by clinicians or researchers in which patients are asked.
"questions [that] target the onset and duration of symptoms, subjective distress, impact of symptoms on social and occupational functioning, improvement in symptoms since a previous CAPS administration, overall response validity, overall PTSD severity, and specifications for the dissociative subtype (depersonalization and derealization)."
Formal interviews, questionnaires, surveys, and other modes of (active) self-evaluation are notoriously flawed (See Physics Envy) yet form the foundation of diagnoses.
The challenge of treating conditions of consciousness has been, in part, the challenge of defining them.
Digital Phenotyping seeks to objectively quantify the lived experience that the CAPS-5 captures subjectively by gathering, processing, and gaining insight from "passive data":
"How you passively use your smartphone—typing, swiping, scrolling—is a new way to measure things like your stress, mental health symptoms, and well-being. If you're typing more slowly—even by a millisecond—it might mean there’s a change."
The above description comes from Mindstrong's website.
Mindstrong, as far as I can tell, is leading the field of Digital Phenotyping by collecting this type of data as well as offering telepsychology/psychiatry services.
From a 2019 Medcity article:
“[Mindstrong], a California-based startup, has developed a research app to continuously monitor users’ phone habits, keyboard accuracy, and speed for hints about mood and memory changes associated with depression. The company’s research has shown that specific biomarkers from human smartphone interactions that are associated with cognitive control and reward correlate highly with activity in brain areas that are implicated in those same domains."
They recently raised $100 Million to scale their offerings.
Do you know what else is notable about Mindstrong?
They're partners with COMPASS Pathways.
Digital Phenotyping in Psychedelic Integration
Psychedelic therapy is powerful stuff.
While there is obviously great potential for the treatment of serious illnesses the psychedelic experience can also create the illusion of transformation. In such instances, the much-hoped-for long-term benefits are not realized.
In this domain of psychedelics for challenging conditions like use disorders, PTSD, Depression, etc. we tend to think in terms of exposing and dislodging some core psychological/emotional/spiritual "root cause."
However, the problem is that sometimes it works and sometimes it doesn't.
There is no shortage of people leaving psychedelic retreats filled with relief, joy, hope, and optimism only to find themselves back where they started shortly after.
Set, setting, and integration are prerequisites for the rollout of such powerful tools in more conventional settings. Still, the success can be undermined when the "root cause" has not been fully exorcised, and self-destructive behavior or mood dysregulation re-emerges and evade one's awareness and that of one's therapist.
Such is the role of Digital Phenotyping.
This perspective is very much informed by my own experience and the challenge that I continually face with depression and self-destructive use of drugs and alcohol. I know how easy it is to fool myself into thinking I have cracked the code or have it under control. I know how difficult it is to be honest with myself and seek help prior to “needing” it.
If the promise of Digital Phenotyping is to deliver support, connection, and intervention in real-time, before an episode that could lead to harmful behavior, one might later regret then such technology is worthy of exploration.
Fear not, we'll have a look at the downsides in the future.
Thanks for reading, have a great weekend.