More Than Tech Support

How we can use technology to improve health.

Self-Monitoring Made Easy

It’s not just for engineers anymore.

For those of us whose New Years' resolutions were never realized or did not last past January 7th, the missing element may have been self-monitoring. Self-monitoring is possibly the single most important mechanism in changing any thought or behavior. It is an extremely broad term which encompasses tracking nearly any pattern from which to move forward and assess your progress (or lack of progress) towards a goal. It's a skill that is so engrained in our lives that we forget we are constantly monitoring ourselves in various ways (e.g. stepping on the scale, looking at the speedometer, counting calories). It is the basis of that ah-ha experience - wow do I really (insert habitual or outside of consciousness pattern here) that much or that little? Self-monitoring allows us to uncover necessary changes and set realistic goals. This is why it is such an essential part of changing any behavior. In fact, study after study has shown that simply monitoring your behavior is a powerful intervention in itself. The problem is that self-monitoring required planning, motivation and vigilance - things that most of us trying to change a behavior lack (hence the reason we have a problem to begin with). Fortunately, there are a range of technologies -old and new - which make self-monitoring our behavior easier and more effective than ever before.

Possibly the oldest most accessible form of self-monitoring technology is creating an audio, still image or video recording of yourself performing (or not performing) a target behavior and reviewing it at a later date. Audio and video review gives you a glimpse into subtleties from body movements, to what you are eating at each meal, to patterns of speech that are automatic and pass through our consciousness without notice. Audio and video self-monitoring techniques are used in nearly every optimal performance training program and can have special clinical applications with problems like social phobia and addiction when done under the supervision of a clinician. As I have previously pointed out in an article on using audio review to help combat fluctuating motivation - hearing and watching oneself can be quite anxiety provoking for some because it magnifies all of the negative traits we typically suppress. Therefore, it should be handled with care and never used to highlight extreme negative behaviors. However, when done to change a mild deficit or to highlight a positive behavior it can create powerful and profound insights that can lead to long-term realization and behavior change.

There are plenty of applications that will allow you to enter specific information over time and then provide you with graphical displays of a target behavior. For example, you can click a button every time you have a craving for a cigarette and that information can be used to help you implement behavioral strategies during those times. While these simple diary methods are the basis of self-monitoring, they require you to be vigilant about tracking your behavior (and force you to face the reality of your actions) and therefore can be like getting a root canal for some people. Text messaging programs and mobile applications that provide assessments are great ways to get that external reminder to make sure you are tracking your behavior. These programs can also be great electronic nags because they will not stop prompting you until you respond - something that simple calendar alerts cannot do. However - you still must respond or enter data for these programs, which can be a barrier to those who might be less than motivated.

Say hello to actigraphs, accelerometers and GPS - the ultimate passive technologies. If you want to assess how many steps you took or when you have the most trouble sleeping and examine how you have progressed over the week all you need is a smart phone or a device the size of an eraser. The addition of GPS extends to tracking where you have been and where you should be going - or not be going. For example, individuals attempting to reduce their drinking might put in the location of certain bars and be alerted as they approach these tempting situations and be redirected to the closest AA meeting instead. Depressed individuals can be alerted and motivated to act if they do not take a certain number of steps and/or go beyond 1 mile from their residence by a certain time of day.

The newest incarnations of these technologies are attempting to integrate smart phone features with biomonitoring and biofeedback technologies. While this has been happening for years in specialty settings there is now an emerging group of small devices that can track every heartbeat, electrical impulse through your skin, blood pressure oscillation, muscle contraction and brainwave that you have - and alert you when they are irregular or pass a certain threshold. There use can extend to nearly any behavior change goal as they offer a glimpse into previously unconscious signals in your body. Moreover, while most of these devices are simply monitoring devices - more and more you will see devices that offer a biofeedback component to guide you to relax when you are feeling your worst and let you know when you have achieved some balance in your body. Ahhhh.....

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Despite the promise of these wonderful technologies, they do come with a downside. As mentioned above, audio and video review can increase anxiety for some - this is also true of biomonitoring technologies. This is called biofeedback induced anxiety and can occur when we are aware of our bodily signals but cannot manipulate them to a desired effect. Typically - this is best avoided by simply taking off the monitoring equipment and practicing becoming aware of specific bodily cues while NOT connected.

A more troublesome side-effect may be the increase in our bodies stress response as we are constantly bombarded with outside cues. We do not yet know the full implications of getting reminders about our HR every hour or having an alarm sound when we pass a certain physiological threshold but the initial evidence suggests that receiving alerts and prompts temporarily increases our sympathetic activity (stress response). What we do not know is whether the content of the alert impacts our how minds and bodies responds to these cues nor do we know if constant monitoring will forever change how we process information and these reactions are simply part of the acclimation process. Recently, there has also been discussion about how the constant connection to technology may inhibit our brains downtime when memory consolidation and learning take place. Like anything moderation is key. Moreover, one could make the argument that switching out your Justin Beiber Twitter feed with a gratitude reminder might be a good start.

So what does all this mean? Ambulatory and mobile devices have completely revolutionized self-monitoring because you can now record and/or track your behaviors passively or be reminded to perform an action exactly when you need it most. These new technologies have made monitoring your behavior easier to swallow than a pill and in my years of treatment experience - ease of use - is hands down the best predictor of adherence. Moreover, you can't trick these devices easily so what you see is what you get. With nobody to sugarcoat your results you can obtain an objective account of your behavior allowing for greater self-awareness - even when you don't want it! But remember suppressing unwanted thoughts and behaviors serves a purpose. Ignoring our problems allows us to temporarily live in peace albeit in a state of denial. But once those negative thoughts and behaviors start to interfere with our lives we need to change them. The first step - without question - is to begin the process of self monitoring. Fortunately these new technologies are available and can provide us with a much needed glimpse into our behavior when we are ready to embrace them.

For those interested in self-monitoring- I highly recommend checking out the Quantified Self website (www.quantifiedself.com) or going to a local Quantified Self meet-up group. It is a bunch of rogue programmers and medical professionals demonstrating the latest technologies through personal self-monitoring projects. For professionals I also recommend going to the Association for Applied Psychophysiology and Biofeedback website (www.aapb.org).

This would appear to be an appropriate time to highlight that I will not mention any specific product in this blog - but will mention global technologies that may help you improve your health or the health of your clients. If I do mention a product I will be sure to disclose the reason why and any possible conflicts of interest I may have with the company. For example - in addition to my research with non-profit agencies - I own a health text messaging company - so take whatever I say about text messaging with a grain of salt! Be well.

 

 

Frederick Muench, Ph.D., is a Senior Research Associate at the National Center on Addiction and Substance Abuse at Columbia University.

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