A mobile Enabling Technology to promote adherence to behavioral therapy

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DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (06) Enabling Technologies, 06-DA-105: Improving health through ICT/mobile technologies. The ultimate goal of this research is to fundamentally change the ways in which behavioral interventions are delivered. We propose an innovative mobile Enabling Technology-iHeal-that recognizes stressors that threaten a patient's recovery and then delivers evidence-based interventions exactly at the moment of greatest need. Our objective is to determine, within subjects, the extent to which physiologic and affective changes detected by iHeal are predictive, within subjects, of posttraumatic stress or drug cues. The study team has considerable expertise in technology development and in assessment of behavioral interventions in co-occurring disorders. We will study 25 subjects drawn from an existing SAMHSA-funded investigation that utilizes intense case management to monitor progression of PTSD and substance abuse in returning combat veterans. Our proposed investigation will share interventions with the SMAHSA study that are based upon a blending of Motivational Interviewing and Cognitive Behavioral Therapy approaches for PTSD and substance abuse. Specific aims: 1) To evaluate the accuracy with which iHeal characterizes physiological and affective phenomena as acute stress reactions related to PTSD and environmental drug cues; and 2) To evaluate the effect of Motivational Interviewing-based interventions on acute stress reactions related to PTSD and environmental drug cues. This initial proposal is extremely innovative. The proposed iHeal device will employ cutting-edge wireless technology to link wearable sensors to personal mobile computing platforms (e.g., iPhone). This linkage will allow iHeal to detect co-occurring biological and behavioral processes, while embedded computing in the mobile platform permits iHeal to deliver evidence-based empathetic interventions at the opportune moment. iHeal can learn to intervene in ways that are most effective for the user, including scripted text-based dialogues modeled after brief interventions; use of motivating images or messages from loved ones; playing a meaningful song; or contacting a counselor at the moment of greatest need. Ultimately, a wearable wireless device that anticipates stressors and intervenes at a likely transition to risky activities has enormous potential in a variety of social, behavioral, and biomedical research enterprises. Importantly, iHeal has immediate commercial applications that will encourage job growth in behavioral science, biomedical, computer science, telecommunication, and electrical engineering enterprises. iHeal is an innovative device that uses wearable sensors to detect pulse, skin conductance, and acceleration; the sensor array links wirelessly to an iPhone which has an app that identifies changes in the user's physiology. Changes consistent with acute stress from PTSD exacerbations or drug use cues generate an empathetic conversation between the iPhone and the user, who enters real-time data on social/behavioral/environmental contexts. The iPhone (which tracks time and GPS data) uses predictive software to anticipate upcoming stressors and helps the user avoid them. The public health significance of this proposal is 1) iHeal will detect co-occurring biological and behavioral processes in real time; 2) it will discern undiscovered behavioral states; 3) it will predict a behavior of interest; and 4) it will deliver empathetic interventions to the user at the opportune moment for intervention. Because it is based on the union of existing technology and has immediate commercial applications, iHeal will encourage job growth in behavioral science, biomedical, computer science, telecommunication, and electrical engineering enterprises.