Q: What do you get if you cross seasoned psychological cognitive behavioral therapy (CBT) techniques with modern app design? A: Moodnotes: aka the lovechild of London-based digital product studio ustwo — maker of minimalist mobile game Monument Valley, among other apps — plus LA-based m-health app maker Thriveport.
“Moodnotes is a health journal for you to capture your feelings and improve your thinking habits,” says Alana Wood, ustwo UX designer. “It couples positive psychology with CBT and off the back of logging your mood it acts as a catalyst to get you into journaling and then it’s through the journaling that we tailor the content, in quite a simple way, whether your mood is more up or down… to prompt users to think more in depth about the situations that they’re facing and how they’re feeling and thinking whilst they’re in those situations.”
The other half of this joint venture, Thriveport, was set up by a pair of U.S. psychologists with the aim of building “scientifically sound” apps for the emergent m-health space. Their first app, MoodKit, has been in the market since 2011. And has gained users from the mainstream, as well as attracting utility as a tool clinical psychologists recommend their patients use, according to co-founder Edrick Dorian — although he won’t disclose exact user numbers, saying only that it’s in the “tens of thousands” and demand for the app has “held steady for the past four years”.
Moodnotes, launching today on iOS (iPhone and Apple Watch) also as a paid app (costing $3.99/£2.99), extends Thriveport’s reach into the m-health app space with a second iOS app focused on promoting emotional and mental wellbeing, but this time incorporating the interface and UX design pedigree of ustwo via a partnership that’s initially agreed to run for two-years.
Moodnotes is an intentionally more streamlined experience than MoodKit, says Dorian (he describes the latter as a “Swiss Army Knife of mental health tools”), with a more fixed focus on mood tracking and journaling as a way to help users understand and modify their thought processes with the aim of promoting general emotional wellbeing.
It’s being launched as an MVP at this stage after eight weeks dev time (with no iCloud integration as yet, for instance), and content and feature-set aligned with its $3.99/£2.99 price-tag — allowing the team to get an app launched within a tight delivery timeframe, test the market, and then iterate based on future usage, says ustwo’s business director Nicki Sprinz.
“We put together the maximum content that suits that price point that people feel they are getting value… but there’s enough revenue for us to be able to support the maintenance, growth and design of the platform,” she says, explaining why they’ve steered clear of a subscription model at this point.
Moodnotes has a playful interface that lets users quickly log their mood by swiping up or down on a face to move from neutral to happy or sad. From there they can do a quick save and leave it at that if they just want to do mood tracking. Or there’s a button to tap to add more details — at which point the app prompts them to start journaling to flesh out the feelings behind the mood they just recorded, including the ability to tag entries with positive or negative feelings (such as ‘anxious’ or ‘content’).
“Depending on how much time or motivation the user has, they can progressively go deeper with their journaling practice. And we thought… to frame it as a tangible journal was quite important because it’s a social norm, journaling, so essentially we wanted to also get around this kind of stigma associated with mental health and focus it on emotional health and just simply the act of journaling,” says Wood.
The flow of the app changes depending on the emotions the user expresses — so if they start tagging their day with more negative emotions they will unlock different prompts than if they are expressing positive feelings.
“Depending on if you’re feeling low then it will start to bring in that CBT content to help you to unpack in more detail how you were thinking and approaching the situation — and then it will kind of give you an antidote in terms of how to think about things differently for the future and what to look out for,” says Wood.
“But then if you’re feeling more positive then what we found through testing is when people are in a more uplifting mood they don’t want to spend too much time in analysis. So then we limit the questions simply to more positive psychology type of questions around the kind of gratitude journaling, and that kind of thing.”
The app also charts mood logging so users can get an overview of their emotional state over time.
“It’s quite interesting because it has a lot of versatility around it. It’s simply a facilitation experience, and so people make from it what they put into it,” she adds.
Content is stored locally on the device, to preserve user privacy of such sensitive personal information. “It’s quite different to your average quantified self logging tool,” notes Wood. “It’s really personal… so for now we wanted to keep it quite self-contained.”
ustwo has been beta testing the app with around 500 users before launch, and has found people are using it in a variety of different ways — although most people are using it two to three times per week, rather than (as it had expected) multiple times per day.
“There’s some people we’ve noticed that they use it just when they’re facing situations where they need to break free of the thinking habit or the style that they are stuck in… and then some people are using it daily to log their mood but they don’t go that deep in terms of their journaling habit,” says Wood. “And then some people are using it to figure out what makes them more content, day to day.”
“It was quite an interesting design challenge because there’s legacy ways of doing something within the psychology space, so we wanted to be true to the kind of scientific roots of that discipline, but at the same time we were really pushing the boundaries in terms of how could we make this a customer facing application that was slightly playful but not too playful, simple, intuitive but not patronising, not too academic but still intelligent,” she adds. “We were constantly trying to strike the right notes.”
While there are quite a few apps in a similar space — from journaling apps like Momento to life tracking apps like Expereal — ustwo reckons Moodnotes has something a little more well-rounded to offer than what’s already out there.
“It’s more than a mood tracking app, it’s a journaling tool,” says Wood. “I would say it’s on the cusp between the two. And the benefit of this one is it can provide value to the user depending on whether they are encountering a negative situation or a positive one. They can still learn something about themselves and grow their self awareness.
“A lot of the mood tracking apps or the apps that target more anxiety or depression… tend to go a bit more towards unpacking those negative situations and then I think it’s done its jobs. Our app is giving something to people on both sides.”
For ustwo, the m-health space is a brave new world. Its main focus to date, aside from commercial work building apps for other companies, has been games — with the aforementioned Monument Valley and other in-house efforts like Whale Trail, plus other consumer apps such as messaging apps and then last year another joint venture project for the fan-focused Dice mobile gig ticketing app.
Efforts with Dice are ongoing, but ustwo’s Sprinz said the company was keen to diversify its output further — hence the push into m-health, and the partnership with Thriveport.
“The background is that most of the studio is really interested in doing some work in the health and wellbeing space, and we’re aware of the fact that unlike, for example, finance or retail where we have a huge amount of experience in those areas, health is more of a passion point — but we have less on the ground product development experience. And so we were looking for ways, as part of our investment projects and internal research, to uncover more work that we could do and put new lenses on problems that we were aware were affecting the industry,” says Sprinz.
“When we formed some interesting proposition ideas we were aware that in order to really make a difference in the health space we needed to convene the right kind of partnership,” she adds.
Thriveport’s Dorian says the focus of the partnership is about “enhancing the design element to make it more engaging, more accessible, have even broader mainstream appeal”.
You can have a delightful or pleasant experience with the app and yet be exposed to content that is normally found in therapy.
“You can have a delightful or pleasant experience with the app and yet be exposed to content that is normally found in therapy, or through clinical self help books but in a way that you don’t normally find cumbersome or dry or boring,” he adds.
“With Moodnotes it’s a return to the basics but given how the technology, including design knowledge, UI advancements and understanding has evolved over the past five+ years [since MoodKit launched] it enabled us to take a fresh look at how we would deliver this sort of content with high design but a very focused objective for the app.”
How much hard science underpins Moodnotes (and MoodKit)? No random placebo-controlled trials as yet, but Dorian, who is a board certified clinical and police psychologist, argues this is largely down to the newness of the m-health space.
“This area of research is in its infancy but a fair amount of research has emerged over the past half-dozen or so years pertaining to the feasibility, usability, and, more recently, efficacy of such apps — with findings that are generally quite encouraging, albeit limited,” he tells TechCrunch.
MoodKit is also now part of a “large-scale controlled efficacy trial” currently taking place in Australia, adds Dorian.
There are other m-health startups using apps as a delivery mechanism to scale up access to CBT. Big Health’s Sleepio, for instance, which uses CBT methods to help insomnia sufferers get a better night’s sleep. That startup has conducted a placebo-controlled randomized trial to support its claims that digital sleep interventions can be helpful, but it’s unusual for doing so — and claimed it as the world’s first such trial for a digital health product.
One thing is certainly true: m-health apps can be lower cost way of delivering CBT vs going to therapy, although Dorian also argues they can work well as a therapy supplement (but of course not everyone can afford full-time therapy).
When well designed, apps also hold out the promise of a more accessible way in to CBT techniques vs the other low-cost alternative of self-administering CBT from a book. So MoodKit and its ilk are effectively the digital forerunners shaping the next generation of self-help tools — aiming to build on the size and success of the very large (and lucrative) self-help book market by leveraging the power and ubiquity of smartphones to deliver CBT content in new ways.
“I’ve had so many patients tell me in my direct work with them they just so appreciate not having to pull out a pencil and paper, that they can just write onto their phone,” adds Dorian. “More importantly, if they’re reading content that they wouldn’t normally want to be seen reading in public — like ‘overcoming your personality disorder’, or something — they don’t want that book exposed on the bus. And so it’s discreet.
“For all people know you’re simply texting or writing an email or what have you. In reality you’re probably selecting feelings or evaluating your thoughts or making a journal entry. So I think that’s probably it’s biggest win over self help books, among many other reasons.”