di , 03/05/2021

A story about how the application of various technologies in digital health – including sense of time research – segues into a conversation about change behavior in healthcare and the general approach to treatment and prevention.

GiulioBreakthrough innovations often emerge on the edge of two or more science areas, which is why Digital Health Blogs decided to interview human-computer interaction expert Dr. Giulio Jacucci, a Department of Computer Science Professor at the University of Helsinki who has coordinated and co-founded numerous projects and ventures in digital health.

Giulio’s research field and competencies lie in the areas of multimodal interaction, interactive intent modeling, and mixed reality. His industry of focus today is healthcare: Giulio’s projects include sense of time studies, the use of VR to treat mental health disorders, and the use of conversational agents to support active aging and formulate a patient’s story.

Giulio is also a Board Member at Etsimo – a startup developing a platform for delivering data-driven digital health solutions (you can learn more about Etsimo in our interview with CEO Thomas Grandell here).

Giulio, considering your vast background in computer science, what is the story of how you became active in the digital health space?

My research is indeed centered around human-computer interaction, and, let’s say, around studying user experiences and technology that supports people doing what they want to do in better ways. Quite a long time ago, I started looking closer at how technology can support changes in people’s behavior and adapting sustainable practices in different areas, like saving energy or choosing more sustainable means of transport. Eventually I became involved in applying the change behavior approach to the health domain, including mental wellbeing.

For example, one of the projects I work on is about gestational diabetes. The use of technology could be extremely helpful for at-risk women because they are going through a very challenging moment in life: their bodies are changing, their lives are changing, they have to rethink exercise, diet, and so on. It’s quite a lot to handle, and technology can be used to support this change behavior.

Another area with ample opportunities to benefit from technologies such as AI or VR is mental health, and I’m also quite active in this segment.

Tell us more about the research you are doing in the mental health space.

I am involved in a project called VirtualTimes that uses VR to help people with disorders like anxiety, depression, or autism. The project is a European multidisciplinary consortium of neuroscientists, therapists, VR, and technology experts that is coordinated by German Forschungszentrum Jülich, one of the largest research centers in Europe. Among other partners, we have the University of Helsinki and Psious, a company that uses technologies such as VR and AR to treat anxiety disorders and is also developing a VR platform for therapists and mental health professionals. (Xavier Palomer Ripoll, Cofounder of Psious, took part in the 2019 Frontiers Health Conference as a speaker and was also involved in Frontiers Health Fast Track in Barcelona.)

There are plenty of companies in the market that use VR to deal with mental health issues, but there are two things that are completely new about our project. First, we are conducting research on manipulating human sense of time to study and potentially treat mental health disorders. Sense of time is a shared experience, but it can be disturbed for people with psychopathological conditions. For example, patients suffering from depression are more likely to feel ‘stuck in time.’ Time disturbances are also reported by schizophrenia and autism spectrum disorder patients.

At VirtualTimes, we are using VR to speed up or slow down the time experience of patients. For example, we put them in a virtual waiting room and measure their reaction to different objects and stimulus. The velocity of a virtual sun in a VR scene in particular influences people’s sense of time.

Second, another novelty of VirtualTimes is the use of electroencephalography (EEG) in our research. The electrode sensors measure the micromovements of your muscles, variations in your heart rate, and changes in your skin’s electrical properties (when you get excited or angry, your perspiration increases, which influences how your skin conducts electricity). Leveraging these two novelties allows us to measure patients’ reactions very carefully and extract a lot of data from the studies.

Does that mean we can find a cure for depression and anxiety by manipulating our sense of time?

Although it’s a long-term objective that we hope to achieve in a few years’ time, the idea of VirtualTimes is to investigate whether we can understand more about mental health disorders and possibly even find a VR-based therapy for them by changing our perception of time. Virtual rooms can be also used to diagnose what kind of type of disorder you might have. Obviously, we can control variables such as density, speed of movement, and synchronization, which would be much more complicated to measure during a real-world session.

Another digital health area attracting a lot of attention right now is longevity and aging. Can you reveal more details about your work around this?

Formulator is another startup that I’m working on together with an Italian colleague who is an expert in AI healthcare applications, Professor Giuseppe Riccardi from the University of Trento. We use conversational agents to formulate the stories of patients seeking mental health help instead of standard questionnaires.

Our approach is more narrative than the existing questionnaires that are used to determine what is wrong with a patient, and we aim to have the right questions in the right sequence to have a consistent story about their issues. This story is then presented to the medical professional(s) and patient so that both can align and provide feedback. Obviously, digitizing the stories is key here because it provides an exceptional view of the patient’s background and uses quite homogeneous data.

I am also curating another European research project centered around active aging called CO-ADAPT. The consortium formed to carry out this project leverages renowned research groups and commercial players from Finland, Belgium, and Italy and is coordinated by the University of Helsinki.

It’s a complex project consisting of various phases and studies that aim to support healthy aging – with a strong focus on mental wellbeing – and workability, that is to preserve peoples’ capabilities as they age. By the way, another member of the consortium, the Finnish Institute of Occupational Health, is esteemed worldwide for their contribution to workability.

The portion of CO-ADAPT that I’m most involved in is the use of conversational agents that could accompany aging people and collect data about them to help with everyday choices and engage them in positive change behaviors. We run studies involving people over 50 looking for support with mental issues. We want to discover how the everyday use of conversational agents might be helpful to their wellbeing.

Chatbots are already everywhere, but I think most are created to enforce established healthy behaviors. What I mean is, when you have already decided you should walk more, there is a technology to help you walk more, set your targets, and so on. But how do you actually decide you need to walk more? Why not run or use a bicycle or some other option?

Here we step into the area of preventive medicine…

And to me it is one of the most fascinating digital health challenges! It is very much connected with change behavior in health. Because if you’re healthy, why should you, let’s say, stop drinking? When do you need to decide to reduce your alcohol consumption if you don’t have any bad effects yet, but might develop them in future? How do you actually achieve this preventive approach?

I am excited about preventive medicine because there are infinite number of ways to lead it. When you go to see a doctor for a preventive consultation, what should happen during this session? In Finland, when you turn 50, you’re invited for a health check. But what is the evidence-based approach we should follow to perform this? Which questions should be asked exactly? It’s a complex thing to address, so we see a lot of potential in the preventive medicine use of conversational agents that will allow us to rely on extensive data and help document the history of a particular patient. Consequently, we do a lot of work with CO-ADAPT to determine what kind of assessment and personalized recommendations are needed to stimulate healthy behaviors.

Can this preventive approach be applied to both physical and mental health?

You may have noticed that the latest healthcare trends follow the idea that distinguishing between purely mental and purely physical issues is not always clear-cut. One line of thinking that I see emerging more frequently is that when dealing with a patient who has, for example, diabetes, a mental health aspect must be included in the diagnosis and treatment process.

I’ve also seen research moving in the direction of an integrated outlook on physical and mental wellbeing. According to general practitioners, a big percentage of patients seeking help for physical problems in the general health sector have psychological rather than physical factors underlying their condition.

It means that if we think of reducing public health costs, we need to rethink, first, how we approach diagnostics and prevention using all available patient data, and second, how to build treatment processes so that mental health issues aren’t overlooked in dealing with physical diseases. This is where we start talking about the digital and organizational transformation of healthcare in general.