Quirk – Open-Source Cognitive Behavioral Therapy | Hacker News Reader

Quirk – Open-Source Cognitive Behavioral Therapy

github.com

346 pointsflaque62 comments

Psychiatrist here... bravo. The feature creep, lack of rigor, and overtly commercial nature of most CBT lite apps is precisely the reason I've been reluctant to encourage their use, vs carrying around an index card. Do one thing and do it well.

Thank you!!

What CBT techniques have you found the most successful in your experience/practice? Thanks!

As a psychiatrist what about hn makes you follow it / interests you ?

There was also a heavy vehicle mechanic which was also surprising

A very good addition to this app would be the vertical arrow technique outlined in David Burns book. It's basically when you drill down a thought by asking "what if it is true" and then write the distortion for every thought in sequence.

I missed George's birthday

> what if it is true

George must hate me

> what if it is true

Everyone who knows George will hate me too

> what if it is true

I will become a social pariah

> what if it is true

i should have been more careful

> what if it is true

I'm not a good person

> what if it is true

...

this really helps you get to the root of your automatic negative thoughts (or ants) quickly

Really? That example looks more like a way to pile guilt on yourself.

The point is that it helps you get to the root cause of your “automatic thoughts” by discovering the false thought driving them. Replacing that one is usually far more effective than replacing “surface” ones.

Yes people who are depressed can think like this and such illogical thoughts may sound true when you're feeling down compounding the sadness.

This exercise helps you rip apart each such illogical thought and shows you how irrational and illogical you're mind is being thereby undoing the illogical connections the mind is making

That chain doesn’t seem too illogical, maybe George is influential within the group and took offense

This example doesn’t help sell the technique

Maybe but no matter how important George is.. the connection from missing George's birthday to I'm not a good person is super illogical in every scenario.. yet somebody who is depressed can make that connection and that's what the technique helps to see and fix

> "Don't be sending it to some server without making that clear within the app, not within some dumb privacy policy no one will ever read."

I think it would be a good idea to state in the AppStore description that no data entered (or derived from it) is ever send to any server/leaves the device...

(since you're basically training people that it's okay to enter this type of sensitive info into apps.)

This is a good point, will do.

Made an account just to make this comment. It's awesome that you put so much thought into protecting private thoughts. However, I think a password lock for the app is mandatory. Thinking about my own automatic thoughts, I would hate it if, for example, I gave my phone to a friend or my girlfriend to check something out and they accidentally bumped on my private thoughts. This makes me hesitant to use the app and it's a shame because I love the design and feel it would be very useful against that pesky automatic thinking.

IMO it shouldn't contain that feature. There are high quality apps for locking access to apps with loads of functionality and customization this developer simply won't be able to match, because it deserves a whole app on its own. Why not use these?

iOS perspective: Because apps can‘t have this far-reaching permissions on other apps (and, adding my 2 cent, that‘s one of the reasons I still stick with Apple, even though their hardware and software quality is steadily declining).

An example on iOS being?

I didn't consider that, sorry.

Agreed. Probably a bit of a dealbreaker

This is something I’m kind of “working towards” incrementally. It’s on the road map, but I haven’t quite figured out all the details yet. You need a settings screen and a in app alert box to do it correctly, so recent updates were tackling how to fit those into the design well.

In the meantime, I swapped the labels of the buttons to be “alternative thoughts” which, by definition, are a lot more rational and hopefully less sensitive.

For example here’s my alternative thought screen: https://drive.google.com/file/d/1snJ-lyZwAWkrF9c2V0V0p-e1X3Y...

This is great, I love the design!

Something I’ve noticed is just how expensive medical apps can be. When I was younger I trialled a program with an optometrist to strengthen my eyes, that would have cost upwards of $1000 to use at home. That night I replicated it in two hours with Python.

I wonder what other applications could be cloned and released as open source, would be a massive benefit for lower income patients.

Please share!

How do you strengthen your eyes?

Looks pretty cool. I didnt know what CBT did but reading through your app helped me understand. Maybe start with a quick explanation of how CBT works and then explain how hte app helps you along.

Seems to me that this trick could help in better decision making even with an audience which doesnt identify of needing CBT. Maybe branding it as a general purpose utility might help adoption.

> with an audience with doesn’t identify as needing CBT

Agreed, it’s super useful for day to day stuff.

Take a thought like “I took too many hints in that interview question.”

That thought might lead to “I must have failed that interview” which leads to “I’ll fail all the rest of my interviews” which leads to “I’ll never get another job” which leads to “I must be really bad at this, I should just give up.”

Each step seemed kinda logical at the time, but one thought led to the next and now you feel awful.

CBT is a counter measure to this; it stops you at that first point and gives you a bunch of common logical fallacies that help you recognize why your thought is overreaching. You don’t know if you really flunked that interview, besides flunking one is good practice to pass the next one.

That thought process isn’t exactly a mental health issue, but it’s common for people to suffer from. You don’t have to feel that way, and CBT is a way to have a much more stable and healthy emotional state.

Good illustrated description; to put it in the simplest of terms, the theory is that if you think bad thoughts about yourself, you'll make yourself feel bad, possibly to the point of clinical depression.

It turns out that most of the bad thoughts people think about themselves are wrong, so as a therapy you work on correcting that.

Another CBT app I recommend is Moodnotes. It's made by psychologists and designed so that you can show it to your therapist as well. Maybe the author can get some inspiration and incorporate it into this app?

Very impressive and thanks for open sourcing. I’ve been through CBT and stopped because of the cost. I feel that an app like this can complement those of us that have had face to face time but stopped for whatever reason.

I know this tool will be useful for the social worker / mental health community: especially for patients who can’t afford to have a CBT coach

This is great for those who have already been through a CBT program administered by professionals.

I said it once and I'll say it again, CBT saved my life. When my anti-depressants took close to 2 months to work my doctor referred me to a partial hospitalization program that taught it.

If you know someone suffering from depression please don't install this on their phone until they see a professional.

> If you know someone suffering from depression please don't install this on their phone until they see a professional.

^^ +1 to that. If you're using CBT for a mental health disorder, see someone.

That said, don't let them do nothing. If it's easier to just dip their toe in, don't stop them.

CBT can be used by a wide range of people. That's why there are stepped models of access. Some people will need intensive support. Others will be able to work solo from a book or website or an app.

Thank you. Would you mind publishing it on F-Droid?

+1 to this. I'd also be overjoyed if the app could be locked with a password/fingerprint.

I can, though I’d prefer to find a champion who can help support an f-droid version; at the moment I have difficulty supporting the google play Android version since I don’t have an Android :(

Thank you for this! When I read "Feeling Good" by David Burns I wanted to make a tool like this but never found the time.

I'm grateful you took the time to do it with such a beautiful design :)

Do you plan to make it as website as well?

My therapist wife was quick to exclaim how great this was. Nice job!

Just read your design goals. Thank you for doing this!

In the beginning of the readme the link to the Wikipedia page for CBT points to the section about declining effectiveness, is this intended?

Lol nope! Good catch thanks!

GitHub says there is an Android version but I can't seem to find it

Does this help? https://play.google.com/store/apps/details?id=tech.econn.qui...

Is the android version less stable than iOS? I ask because on the website https://getquirk.app/ , you haven't mentioned it and avoided putting link on Github yet.

Thanks for working on this!

Ah yeah it is at the moment. Working on fixing that, I only have an iPhone, so I’ve been hesitant to heavily advertise the Android version. At the moment its breaking on a fair amount of people’s phones, but working on fixing it

I really appreciate that you don't advertise an unstable version just yet, given what this application is for.

I can’t find the info on what happens to the data, especially within the app. It would be good for this to be stated upfront. For me local vs stored somewhere is a dealbreaker.

Ah, yeah! Data is only stored on the device. It’s never sent anywhere.

This will be helpful to a lot of people! thanks for sharing!

As someone that has been reccomended CBT but never been inclined: I think a keyboard for mobile devices that does this sort of detection on forms and messages could be really helpful for people to help them become more aware of themselves and to help with the feeling they are offloading 'all the little things' onto people, It could help build better communcation skills, I'm wondering if context/explaination why could be explained on request or if this is more of a trainer neural network making the classifications

Cognitive Behavioural Therapy is a way for a person to examine their own thinking, and to provide different thoughts to their automatic thought.

In the example given on the giithub page a person (I'll call him Bob) has just been to interview and feels they did terribly. Bob also thinks that the interviewer now hates him.

Bob (who has a bit of familiarity with CBT) thinks this type of thinking involves "mind reading" (knowing what the interviewer thinks), "fortune telling" (knowing what the future holds), and "catastrophising" (assuming the worst).

The next stages for Bob might be to recognise that he doesn't actually know how the interviewer feels; that even if the interviewer does hate him well so what; that he doesn't know how badly he did at interview; and even if he did terribly well so what, it's still useful practice.

CBT is NOT about a therapist telling you these things. The therapist is merely telling you how CBT works and leading you into it and training you how to use it. You come up with all your automatic thoughts yourself, you come up with the evidence you have to support those, and then you come up with the alternatives and the evidence to support that.

A major purpose of this exercise in CBT is training the subject to identify these thoughts and the defective cognitive pattern behind them themselves. I think a keyboard automating the process for every input might potentially have harmful effects, serving as a constant reminder of the disease and with wrong timing lowering confidence in something the person maybe thought about a lot before writing it down.

What I'm trying to say is, the app OP has published looks nice and offers a digital alternative for a singular mechanism of CBT at the users convenience. The rest is not a tech problem.

How frequently in a day is a reminder healthy?

While most apps I'm aware of in this context come with some configurability in that regard (e.g. letting you choose the time of day, opt out, etc.), I'd say that highly depends on quite a few factors. Just like the frequency of in person therapy visits usually is adjusted by personal progress (at least around here and in the context of CBT), these mechanics aren't applied as the only measure. Assessing your thought process in this structured manner might be helpful one week, while being a thing to obsess about another and other techniques or a mix might have more positive impact.

My main thinking point was the constant nature of the suggestion that I'd have an issue with. It wouldn't really allow to factor in a person's current requirements.

I really really appreciate the detailed writeup on the design/engineering. Thanks for doing this!

Great idea.

Are you open to PRs? This is kind of project I would love to work on.

I am! Though note the project is kept purposefully small in features.

Any chance for you to publish it on F-Droid?

Great idea.

For anyone who wants a book check out Feeling Good: The New Mood Therapy by David Burns.

Please don't downvote this suggestion, for decades Burns' book https://www.amazon.com/gp/product/0380810336/ has been the best self-help guide to applying cognitive therapy, for many including myself entirely adequate for the task. For myself, so good that in 20/20 hindsight talking therapy stopped being useful after reading and applying.

I have given people many copies of it over the years, with no bad results and a few good to very good ones.

Also agree! This was the book that originally turned me on to CBT. It sounds super cheesy, but everyone should read that book.

> 736 pages

Woah, that's a lot more than I expected. I could read that, but I suspect many other people in my life never would. Are there more concise alternatives?

The book is a lot of worksheets and sections for individual problems. Think of it a textbook.

That said, it's still pretty good in audio-book format.

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