Progress Through Pixels: Dr. Kaylee Kruzan on Digital Mental Health Interventions Among Adolescents
Transcript
Lauen Stenger: Kaylee, thank you so much for being here with me today, I'm super excited to connect with you all about your work in the mental health space. I think now more than ever it's really important to talk about mental health. Either you yourself struggles with it or someone you are close to struggles with it. So I really think your work in the field of non-suicidal self-injury among adolescents is really important and interesting. I'm super excited to get the chance to connect with you today.
Do you mind spending a little bit of time going into your three main areas of your research focus?
Dr. Kaylee Kruzan: Thanks so much for reaching out and for having me on, it's an honor. I think it's really cool what you're doing with the podcast. I feel like the three main areas of my research are related and they kind of build on each other. The first one is understanding mechanisms of change in recovery from non-suicidal self-injury. I'll probably say self-injury for the rest of the podcast, but what I'm really referring to is non suicidal self-injury. So basically, this line of my work focuses on understanding context, emotional states, actions and connections that help people to make changes that support their recovery from self-injury, and conversely, what sorts of things are barriers to recovery. So what makes recovery or behavior change difficult. This is really where my research began, but I'm constantly learning more when I talk to people about their own recovery and what they're going through. So I feel like it's very much still a huge part of my research program, and where I spend a lot of time. While everybody's recovery is different, there are some broad buckets that are important to nearly everyone. One of them is social support, connection, and feeling like you're not alone. This sort of led to the second area of my research focus, which is on social media, and how social media is used by people who engage in self-injury, both for their recovery and also to seek out information and connect with other people and understand what it is that they're going through. So a lot of my work has looked at how people use online spaces to support their recovery, as well as what types of interactions on social media are beneficial and what sort of interactions can be harmful. The third part of my research, which is what I spend most of my time doing now, is in developing and evaluating digital interventions for self-injury. My work on social media was kind of brought to my attention, how many people are going online as the first point of contact and trying to understand what they're going through, and so I see my work on digital interventions as trying to integrate resources in spaces where people are already talking about self-injury and trying to get some help.
Lauren Stenger: I think a lot of people blame social media for creating mental health issues. So it's really cool that you're trying to find a way for them to kind of coexist and use this inevitable new digital world we're living in to actually provide treatment rather than more harm. So I think that's really important.
How did you narrow your research into self-injury?
Dr. Kaylee Kruzan: Yeah, that's a good question. Originally, I was interested in mental health more broadly. I connected with my PhD advisor, Janice Whitlock, when I was at Cornell finishing up my doctoral studies and she focused on self-injury. So actually it was sort of just really good timing. We started working together on a project where we were interviewing folks who were at various stages of change, and we used a peer change model to understand how people progressed through the recovery process. I became really interested in the functional nature of self-injury, which is just to say that self-injury is a way for a lot of people to regulate emotions, much like any addiction. It's relatively stigmatized, and so there aren't many opportunities for people to talk about it openly. So I think I really resonated with that. I have a history of eating disorders, so I saw some overlap. I just became fascinated with understanding the recovery process. Also, there wasn't a whole lot of work on self-injury, specifically non suicidal self-injury. So I just felt really called to continue to focus on that group.
Lauren Stenger: It’s one of those really stigmatized subcategories, within an already stigmatized topic of mental health.
How do you take care of your own mental health when you're working with really vulnerable patients?
Dr. Kaylee Kruzan: I think that's really important, because there's a lot of burnout in this profession. One of the ways that I try to take care of myself is by checking in sort of daily. It's important that I'm taking care of myself so that I can be supportive and grounding when I am talking to people who are going through their own sort of struggles. For me, that means taking a couple of minutes, before I go into an interview, or before I sit down with folks, and just checking in on where I'm at, what my anxiety is, physiologically how I'm feeling in my body, of taking some deep breaths, and making sure that I'm in a good frame of mind to be able to go into situations and really actively listen. I keep my eyes open, my ears open for things that I need to be looking for in terms of risk. So it's just a whole lot of checking in with myself. I do yoga, I feel like that helpful for me. Anything that can kind of bring me back into connection with my body is helpful, for me personally,
What inspires you to keep pursuing this field, especially among a group of people who are pretty resistant to receiving treatment initially?
Dr. Kaylee Kruzan: Most of my research is on people who aren't yet engaged in treatment and who are resistant to treatment, and I think that's intentional. A lot of younger people, I don't think that they're necessarily resistant to treatment, but I think that there haven't been treatments that really fit their needs. So for me that's exciting, because that's where innovation can come in. In order to innovate, we really need to be talking to people, which is my favorite thing to do, talking to people about what it is that they want, what they feel like would work, talk to them about their struggles. So that's why I'm a therapist. I think traditional face to face therapy can be very helpful, but there's a need for more diversity. So maybe meeting people online, as a point of entry, and delivering resources and getting people used to talking about mental health, and then maybe that's moving them offline and to some other type of treatment. I just think that there's a whole lot of potential with that population. And certainly, we're seeing a whole lot more concern around mental health with younger folks, in part because of the digital world, I think. But yeah, I'm excited by that, and I see a lot of potential. So I think that keeps me going in this space.
Lauren Stenger: I'm kind of curious because you've been studying this digital mental health intervention for a while now. But I feel like within the past six or past a year or so there's been such a rise of like aI with chat GPT and open AI like that whole industry in itself.
Do you feel like this new ChatGPT era can affect your research and studies?
Dr. Kaylee Kruzan: Yeah, definitely. I think it will, and it already sort of has. There's a lot of excitement right now around ChatGPT and OpenAI and all of that. However, I think there's a whole lot of concern around privacy and ethics and boundary crossing with these new technologies that are relatively black box. We don't really know what goes into them sometimes. I think for me, the most exciting part of it is being able to scale risk management, so being able to identify folks much easier who could be in need of services, or who could benefit from services. I also think that outside of being able to have these objective and precise measurements to identify people, a risk I see is thinking that these models will be able to perform in some way similar to a human. So I still do really think that we need human contact, especially when we're talking about things as complex as recovery from mental illness, because social support is so important. And I think modeling empathy isn't really the same as being an empathetic relationship. At the same time, one of the critical needs in mental health is that we just don't have enough mental health providers for the number of people who need services. So I think that as a field, we need to be thinking carefully and creatively about where these systems can be helpful, and what guardrails we need to have in place to make sure that we're protecting what we know already works.
What was a study that you conducted that you felt was the most influential or pivotal for your career?
Dr. Kaylee Kruzan: I don't know if that study has been done yet, I feel I’m still learning! One of them that has been really influential is the recent study that I did that set up the work that I'm doing now with Coping Compass, which is an app that I am developing and will be going to trial soon. It's an app that we developed for young adults who engage in self-injury. The first study that we did in this series was interviewing 20 young adults. In these interviews, I talked to these young adults about their recovery, how they related to their self-injury, what struggles they were having, what things they had tried, how technology fit into all of this. So whether they use technology to connect with people about self-injury, whether they used apps or other sorts of devices to manage their self-injury. I learned so much from those interviews. It really was a privilege to be able to sit and talk to these people about their experience, because it's not something that people open up about very often. So for me, it felt like such a wonderful opportunity. I was just really grateful for those conversations. And then also, I got a lot of really good information in those interviews about how an app could be helpful and the ways in which apps would absolutely not be helpful, things that I should stay away from when I was developing a resource for this population. So I think that was one of the coolest studies that I've done so far, and probably the most impactful in terms of the direction that I'm going in now.
When will your app be completed?
Dr. Kaylee Kruzan: One of the things about academia, and I could talk to you about academia versus industry for hours, but it takes a while. What we're doing now is we're going to be doing a field trial with just a handful of young people who will use the app for a month and then give me feedback. Then we'll do a larger trial after the first of the year, where around 90 young adults will use it for two months. That will give us some data about whether or not it's perceived to be useful, and sort of some preliminary data on the efficacy. But then after that, there's got to be another trial to actually look at the efficacy. So it'll be a while until the app is actually released and can be used publicly. But the goal is to get it in a place where we feel confident about it, and then to actually have it be a resource that's uploaded to Mental Health America, which is my community partner. They have a website where they have lots of resources for different mental health conditions. And they're moving forward now with some resources for self-injury. So it'll be down the line, but hopefully not too far down the line, because technology changes really quickly.
What does a day in your life look like right now? Is your day to day more seeing clients or doing research?
Dr. Kaylee Kruzan: It's super varied. I only see a handful of clients, so most of my days aren't client focused. But I do have a couple of days where the second half of my day is seeing clients. Since we're going to field trial with this app, I would say most of my days right now are focused on making sure that the processes are in place for the trial to run. So part of that is training coaches who are going to be involved in the trial, or making sure that the IRB, the Institutional Review Board, documents are in order, setting up surveys to be released at certain times, meeting with colleagues and community partners to make sure that we're all united around the same vision. Some days are focused on writing. So like, I have data from other studies that I'm writing up in manuscripts to submit to different journals. So yeah, day to day, it can vary a lot. I can have like six meetings one day, and then no meetings one day and just be writing all day. Nothing's really consistent.
You got your PhD in Communication from Cornell. When you were getting your PhD, did you have this vision to go into the field of psychology?
Dr. Kaylee Kruzan: Yeah, I think so. When I was in my undergrad, I did a dual degree in Psychology and Communication. Early on, I had an idea that I was interested in psychology and mental health. However, I decided to pursue Communication because I was really interested in interactions and how people relate to one another, which is just psychology too. I took the communication route and then I did my PhD in Communication, and I was in a Social Media Lab, as well as the Cornell Research Program in Self-Injury and Recovery. I had an emphasis on how social media relates to mental health sort of at the time when all of the research was coming out that was saying that social media was bad for our mental health. I was right in the mix of all of that. And so I think that kind of made me pivot to really strongly focus on mental health, and how our online interactions are related to mental health. I would say like two years into my PhD, I started to think about whether I would want to go back to school to get a clinical degree. And ultimately, I decided to finish up because I was doing interesting work and I felt good with the types of things that I was doing in my PhD for Communication. But afterwards, I decided to go back for a Master of Social Work so I could work clinically with folks. I think that is a really unconventional route, but it actually was pretty great because I feel like I got some strong training in human computer interaction, which is useful for designing and implementing digital interventions. And the training in social work was helpful for the clinical piece.
In your research, you recommend ways to use technology to our advantage through app-based treatment. Do you have any conclusions or recommendations about removing certain forms of technology to support mental health for any adolescent?
Dr. Kaylee Kruzan: I think it's ultimately about balance. A lot of the research that has come out that's shown negative outcomes is around problematic social media use and then heavy social media use. Then there's research that shows that exposure to certain types of content can have a negative effect on folks, which seems obvious, but it's also something that happens so frequently. I think my biggest recommendation would be to sort of check in with yourself and sort of ask, is how I’m spending my time helpful, or is it harmful? How do I feel after I've been on social media? What types of things am I seeing? How are they making me feel? Can I take a break? I think taking breaks from social media is important. Whether that means deleting the app off of your phone for a while, or limiting the amount of time that you spend on the on the site is pretty important. Asking yourself what are you getting from connecting with people. Are you connecting with people? I feel like social media now, you can use it in some ways that aren't really about social connection, and then you can use it in other ways where it really is about connecting with a community. I think those are the most beneficial ways of using social media. I think it's really important to have check ins and be honest with yourself about how these things are making sure you feel.
Where do you want to see improvements in the mental space in five to ten years?
Dr. Kaylee Kruzan: One of the big things is that I'd like to see is insurance coverage improve just generally, but then also on interventions. I think that would be really helpful. We already have some movement towards coverage for digital therapeutics generally, but I think there's a lot of potential for digital interventions to fill in gaps in services where people can't get them, so even on like waitlists and stuff. I'd like to see better insurance coverage of those things. I think also thinking through ways of leveraging peer support. The substance use field has done a pretty good job of having peer support integrated, even from early days. Peer support is so critical and can be useful in lots of different contexts. So thinking through ways of using that safely.
Lauren Stenger: I didn't even think like about that. There’s AA which is so community based. But then for the self-injury field, there's no positive community space like that. So yeah, that would be huge.
Dr. Kaylee Kruzan: Yeah, and I know that some people who have engaged in self-injury will go to AA or NA to connect with the basic processes that they have. think it's so important to hear from people who have experiences that you can resonate with. And so I think that there are probably ways of doing that safely, that have been underexplored. Obviously, I want less stigma around mental health, like it would be great if we could just continue on the line of less stigma. Another direction forward is to figure out ways to support the people that are supporting. There is so much burnout, like I mentioned, especially in community based mental health. And so I think figuring out how to change things structurally so that there isn't so much burnout and that so folks are feeling supported and like they can do their job well and being compensated well, and they're able to get sort of the resources that they need. All of that's really important.
Lauren Stenger: Thank you so much for connecting with me and taking time out of your day. I know you must be really busy, especially with your new app coming out. Thank you so much. I appreciate it!
Dr. Kaylee Kruzan: Thanks for chatting with me about this!
Explore Kaylee’s Work:
Kaylee Payne Kruzan - Home (acm.org)
Kaylee Kruzan: Faculty Profiles: Feinberg School of Medicine (northwestern.edu)
