HealthRhythms: Measuring Behavior to Help Manage Mood Disorders

For someone with bipolar disorder, unpredictable sleep patterns and a lack of daily routine can make the symptoms of the illness much worse. Changes in sleep and wake times, daily activities, and mealtimes can interrupt the daily cycle of physical, mental, and behavioral changes that make up the body’s circadian rhythms.

 Ellen Frank, Ph.D., CEO of HealthRhythms , was part of a team developing interpersonal and social rhythm therapy (IPSRT), which sought to improve the regularity of patients' daily routines (or “social rhythms”) to strengthen their circadian rhythms. But what she really wanted to do was find a way to put it on a smartphone and let technology do the hard work of collecting and monitoring behavior changes.

A chance phone call put her in touch with Mark Matthews, Ph.D., a Marie Curie Fellow working with Dr. Tanzeem Choudhury on developing wearable technology to improve wellbeing at Cornell University. Dr. Matthews was particularly interested in investigating the role of technology in improving the lives of people with bipolar disorder. Drs. Frank and Matthews began working with people with bipolar disorder to develop an app that incorporated the theories of IPSRT to support the stability of circadian rhythms. That app won the Heritage Open mHealth Challenge and a $100,000 prize, which helped Drs. Frank, Matthews, and Choudhury start the company HealthRhythms in 2015.

The HealthRhythms app securely collects user-reported and sensor-measured data from everyday routines, which is then analyzed by the New York-based HealthRhythms team. The monitoring app has been used in several pharmaceutical trials and academic research programs as a research tool to help companies and researchers understand whether social rhythm data may constitute a digital biomarker – an indicator of which patients are most likely to benefit from certain types of interventions.

Funding from the NIMH Small Business Innovation Research program

Now, with help from a Small Business Innovation Research (SBIR) funding grant from the National Institute of Mental Health (NIMH), Health Rhythms is looking to take the monitoring app one step further.

HealthRhythms is using SBIR funding to test an automated intervention platform on top of existing monitoring capabilities that can apply machine learning and predictive analytics to measure and understand behavior. This new platform allows them to see a more complete picture of patient behavior and use that information to push personalized suggestions for behavior changes to the patient through their phone. The plan is to create an app that acts as a personal, virtual therapist to support patients between visits with their health care provider.

The app works by combining data collected through the sensor with self-reported patient data. Patients answer a few easy questions in their app each morning, such as when they woke up, how and when they slept last night, and how their mood is overall. The app analyzes that data, along with sensor and self-reported data from the previous week, and offers suggestions, or support and encouragement.

For example, says Dr. Frank, “If the app sees that someone has not left the house in several days, it might offer a suggestion like ‘What would you think about making a plan to go to the park?’ Or, it might say ‘I see that you’ve gotten out most days this week, and your sleep schedule looks really regular. Congratulations, you’re doing a great job!’”

Currently, the analysis and pushed suggestions are made manually by a team of highly trained psychologists. HealthRhythms is working on automating suggestions related to sleep first, and eventually hopes to generate automated suggestions for a full range of behaviors.

Because HealthRhythms had already done much of the product research and development, they were able to take advantage of a “direct-to-phase II” SBIR grant. “We were able to get a grant to do more of this collaborative design together with patients. We then were able to use the SBIR funding to do a beta test of that first developed product and a randomized controlled trial in which we compared the new intervention platform to monitoring alone,” says Dr. Frank.

Dr. Frank credits SBIR funding for allowing HealthRhythms to focus on laying a solid groundwork for their product and doing the work they think is important. Says Dr. Frank, “SBIR funding is such an incredible opportunity to do the work in the way you want without the pressure of turning profitable immediately.”

HealthRhythms hopes to expand their technology and treatment options beyond mood disorders in the near future. They currently have a grant from the National Institute on Alcohol Abuse and Alcoholism to focus on sleep disturbance as a risk factor for relapse in patients in early recovery from alcohol use disorder.

“I wish more startups could get access to the SBIR opportunity – we had a real advantage,” says Dr. Frank. “I don’t want to sound like a commercial, but I really am! This was such a gift for us.”