How Does Sleepio Put Us To Sleep?

Behavior change is hard. Actively changing another person's behavior is even harder. But there are plenty of companies out there that have been able to crack that code. They understand that people don't always or even rarely act rationally. I'm Kristen Berman, co founder of Irrational Labs. Over the years, we've helped countless companies understand and leverage behavioral science to increase the health, wealth, and happiness of their users. The idea behind the Science of Change was to create a podcast that demystifies the psychology of decision making. So here's how it works. Each week I get to chat with visionary product and organizational leaders to uncover their insights about user behavior and how they've managed to change it. I mash this up with some of the latest research in the field to get to the bottom of our core psychologies. So let's dive in and unlock the secrets behind the Science of Change. The Science of Change podcast is presented by Setsale, the world's number one revenue execution platform. Welcome to another episode of the Science of Change. Our guest today is Kelvin Kwong, the Chief Product Officer at Big Health. They're the company behind the popular sleep app Sleepio, as well as Daylight, an automated digital therapeutic that helps guide users through worry and anxiety. Kelvin is one of the sharpest applied behavioral scientists I've ever met, and, in the spirit of full disclosure, a close friend. In this episode, we riff on a popular but counterintuitive method to deal with insomnia. We talk about how Kelvin uses onboarding questions to drive retention, and we dig into psychology principles like Barnum effect and Hawthorne effect. We're going deep. But before we do, let me set the stage. Calvin and I talk a lot about something called CBT or Cognitive Behavioral Therapy. CBT is not what most of us experience when we go to therapy, so throw out the classic scene of laying on the couch and talking about your worries. Cognitive behavioral therapy is more like a curriculum. It teaches you a set of techniques and strategies that attempt to change your thinking patterns and coping behaviors over time. These techniques can help you overcome and even recover from whatever mental health condition you might have. When I first sat down with Kelvin, I asked him to elaborate on how exactly CBT works. Can you give us an example of a strategy just so we can make it come to life? What is something someone would learn from you?

One great thing about the techniques in cognitive behavioral therapy, and maybe it's worth calling out, that there are, at this point, I want to say, four decades of research on cognitive behavioral therapy in peer reviewed studies, clinical trials, and so tons and tons of Evidence not just behind CBT as a whole, but behind the specific techniques. And what I personally think is really great about cbt, and then particularly as someone who's building into technology, is that a lot of the techniques are counterintuitive. And so one that I like to talk about is in the context of insomnia, that's called sleep restriction. And so if you know anyone who has insomnia, you know, it's really, really tough and can be completely debilitating. And often the folks who use our programs where we get CBT have been suffering from insomnia for many, many years, like five, seven, 10 years. And often folks will say, you know, if I'm tired, I should go to bed earlier and I should try to get more sleep. The challenge is that with insomnia, often folks are laying in bed for a really long time. And so there's often a lot of self doubt about whether or not they can actually they're physically capable or able to go to sleep. And so one of the most powerful techniques, something called sleep restriction, where you take the other approach and you say, well, if you're not getting to sleep, then don't go to bed. And let's first build up your confidence in your ability to actually go to sleep. And so if you're really tired because you haven't been sleeping, don't go to bed at 10pm but if you've only been getting five hours of sleep anyway, and you get up at, you know, 6:30, go to bed at 1:30, stay up until 1:30, find stuff to do, and then when you get into bed, you will fall asleep more quickly. And we think of this as sleep efficiency. And so of the time that you're in bed, what percentage of that time are you actually asleep? And if you're one of those people who's in bed for 12 hours and you only sleep for six, that's not very efficient sleep. So how can we help you with that? And that's an example of one that has sort of a counterintuitive nature to it. Some folks will equate sleep restriction to sleep training. A baby, again, a lot of it is really about developing that perception of yourself, of whether or not you're able to do this. There's another concept called your sleep drive, which is essentially the pressure or sleep pressure to get you to go to sleep. The longer you stay awake, and we've all experienced this, you get more tired and you fall asleep more quickly. And the example I gave where if you went to bed at 10pm Good chance that you're going to be a little more tired at 1:30am and especially if you're still just doing things around the house and living your normal life. By the time you get to bed, the biological elements or physiological elements are going to be working in more of your favor. And then ideally, by doing this for even a short period of time, you start to realize you're like, oh, well, I am able to sleep. But there are other factors at play here. And a lot of times those are cognitive challenges. People may have things like a racing mind or thinking through different things, and that's actually what's keeping them up at night.

How long does this take? If you're going to tell me to do this one night, do I have to do it successfully for five nights? And then magically, my brain is kind of retrained to think that I am a great sleeper. How long do people have to go through this sleep training?

So it really depends on the person. And this is why technology is such a great way to do this, because we can tailor what's called your sleep window. And so in my example, I think I said 1am to 7:30am or something along those lines, or 6:30. The factors that could impact this are, one is how willing you are to actually compress your sleep. And so some folks will say, well, no, I can't only get five hours of sleep. That's just not gonna work with my life. In which case, then you can still do this, but you might just keep a slightly larger window. And so that might take a little bit longer. But what you ultimately wanna do is to first compress it so you are asleep for the majority of the time in that window. And then you slowly grow it to the ideal amount of sleep that you're targeting. And so that can take a few weeks, it could take a little bit longer, but you generally want to do it in a pretty finite amount of time.

How does it actually work? Are you sending text messages to people, coaching them on this? Is there a real coach they're talking to? How are you getting me to kind of change my habits in such a deep way?

This is such an important question. And so what we do at Big Health, we're building purely programmatic solutions. And so there is no human involved. And this is favorable and beneficial for a number of reasons. One is just scale. And so we're able to roll our products out to many people quickly. The other side of it is accessibility, is that, you know, like, if you are having trouble sleeping and you want to use a relaxation exercise, one that I personally love, is called paradoxical thinking. At like 2am it's right there for you. And so the way that we do this is sleepio is modeled more closely to what it looks like to do in person therapy. And so there are weekly sessions and essentially homework or tasks in between. And so to build on the sleep restriction example, in the session you would learn about sleep restriction. So talk through in more detail. But what we just discussed, and then we calculate your sleep window and maybe adjust it with you and then build you a schedule and say, listen, okay, so if this is what you need to do and this is when you need to get up, this is when you need to go to bed. And here are some examples of things that you can be doing. And earlier in the program we talked about wind down routine and sort of more sleep hygiene related things. And that gets built into your schedule as well. And so as we know from behavioral science, like showing prompted planning and showing folks exactly what they need to be doing at a given time can help with the adherence of those types of techniques.

So Kelpin is basically describing something called pre commitment, which means you're getting people to make a commitment to their future self. In other words, sleepio users are making a commitment to themselves before bedtime. That plays out what they will do at bedtime. In general, getting people to think about what they will do before they need to do it means there's a better chance it will actually happen. You're basically asking someone to try something completely new. It's likely gonna be difficult for them the first few times they may not actually do it. Do you have any motivation tips of like how you're communicating with them? How do you basically deal with failure?

Yeah, no, this is a really important one. And a heuristic that we use at Big Health in building these products with clinical psychologists who have been delivering CBT to folks for many years, is that only one in two techniques are going to stick. And so really in order to even affect any change in one's condition, we would generally need to teach them at least two techniques. And so that failure is going to be expected as a part of that. And so I'd say there are two things to call out here. The first is readiness to change. And so this is, you know, Kristen, but for others who don't concept that comes from substance use and it's about whether or not quite literally you're ready to make that change. And when we're talking about clinical conditions, especially something like cbt, the reality is that it takes work. What we really want to do is to ensure that you are ready to take on that work. And so a concept that we have borrowed from in person therapy, but then also something that in sort of the judgment, decision making space we call commitment and consistency is that we explicitly ask for that commitment up front. And so early in both of our programs, we'll talk a little bit about sort of the sort of assessments and stuff up front and how we engage folks. But when we actually get you into the meat of it, one of the first things we do is we make a commitment to you and we ask you to make a commitment to us to give this a real shot. And even sleep restriction is definitely one of the most onerous techniques, but I think that really sheds light on like we're asking people to do hard things. And so if you're not ready for it, that's totally fine, come back to us when you are, but that's where we can really give you that benefit.

Okay, so this is a really clever idea. Most apps out there are hyper focused on reducing all frictions. So you can drive to conversion, which is a fancy way to say, get somebody to sign up for your program or buy your product. Kelvin's saying that Sleepio asks its potential users right up front, look, this isn't going to be easy. How committed are you? Let's not waste each other's time. But of course there are downsides to friction. Would it drive Sleepio users away?

So I think there are two things that we really do in the way that we think about using friction as a part of our design. One is commitment, and it certainly does drive some drop off. I think what's really important is to go one level deeper on that is sure, if you didn't have that step, you would have more people making it to the next step or the step after that. But the real question is how many of those folks would actually be engaged enough to start using these techniques to make a difference in their lives. And that is a much smaller percentage of folks. And so a commitment actually drives some folks to stop and think like, all right, I'm doing this. And then it'll push some folks away who are truly not ready. And I think part of our job is to make sure that we sort of optimize those so that we get true trues and true falses on both sides of those.

There is something interesting here in general about mental health apps, but any kind of thing we're struggling with that you touched on, it's really hard for people to ask for help. And the idea of like raising your hand and saying, I need assistance is difficult. We were talking a while ago and you mentioned finding the right time in someone's journey that they realize that they may need help. How do we think about the right time to get in someone's solution set?

This is a really big one. And I think what you're referencing there, we think a lot about it in terms of what to teach someone and when, which is when we look at roughly what we think of as like a curve of anxiety. And so if you think of the Y axis as like high being, like, you're very anxious. And then you can sort of put whatever adjective you want there. And on the bottom part would be you feel totally calm and fine. And if you imagine it's just like a little bit of a bell curve, what we see is at that peak moment, and you know, a lot of folks won't experience like very peaky moments, but if you think about a time when you are very worried, very anxious, very angry, the weight of the world is on your shoulders. What we've seen is that motivation is often really, really high in those moments. And so if you're feel like the night before, you have a big project to or a big presentation, you would do anything to get rid of that feeling. At the same time, those moments, your cognitive ability is generally lower than it normally is. And so when you're really stressed, really anxious, and so those moments, while the motivation is really high, which is a lot of what we think about, it's also not a great time to introduce new things. And so, especially if we're trying to teach you a technique that requires you to really wrap your head around it, we're probably not going to introduce something that is like cognitively heavy. At that point, you go to the other extreme, like near the bottom of that Y axis. And that's where your cognitive ability is at its normal level and high. But your motivation is really, really low. If we teach you that technique, it's going to feel like your spinach, your broccoli, you're like, oh, I'll bookmark that and I'll learn about that at some point, but whenever I get to it. And so that sweet spot is the in between. And what you're referencing is what we called the after after, which is after that peak, but then even a little bit after that. And so in the moment immediately after that, if it was a little bit more episodic, you might have some feelings of regret. But then it's that moment after where you've kind of like processed those emotions a little bit more, and you're like, okay, now would be a good time for me to do something about it. And so that's when we try to teach you those techniques so that when you're in that peak moment, you actually have those tools that you can use them. And so that's how we think about, like sort of passing along that information to you.

Okay, this is going to take me a sec to break down, but there's a name for what Kelvin is describing. It's called the hurricane effect. So people are more likely to buy insurance to protect themselves after a natural disaster they have just experienced than they are before it happens. But this is the exact worst time to purchase insurance. It's a good action only taken at the wrong time. So why do we do this one? We make probability judgments based on how easily we recall similar instances. For example, managers give more weight to an employee's performance during the most recent three months prior to an evaluation rather than the whole year before, simply because it's more available in their memory. In the context of a natural disaster, if you were just hit by a hurricane, a hurricane is easier to recall. Likewise, if a hurricane hasn't hit for a few years, it will be less easy to remember. This shortcut is called the availability heuristic. Second, we have a strong optimism bias. We assume natural disasters happen to other people, not necessarily to us. We're optimistic, but once we've experienced the negative effects of a natural disaster, we're able to perceive a greater risk of the event happening again. This can lead to action oriented behaviors like buying insurance. So back to Kelvin. The hurricane he's describing would be like having some kind of mental health event, like an anxiety attack. Now, the optimal time to have sought help for anxiety would have been before the attack. But like the hurricane insurance, we often take action right after the event takes place. Okay, switching topics a bit. We talked about getting people in. Let's talk about keeping them. How do you manage ongoing motivation? So how do you think about the problem of retention? Or is it a problem?

Yeah, so retention is absolutely a focus. However, it's not the focus. And I think this is a really important differentiation for what we do is that we are really focused on getting you better from this condition. And so everything from the way our programs are designed to the way that we make money, we're not trying to keep keep you around forever, we're trying to get you better. And so when we Think about that. The clinical term for this is called remission, which quite literally means that for every hundred people who are sick, quote unquote, or in the clinical level of a condition area, how many of those are no longer in that clinical level or are no longer sick by the end of it? Getting that number as high as possible is the end goal. Now, if you take that one level down, then you can see where retention comes into play. Right? Is earlier I said, hey, maybe one in two techniques aren't going to land with folks. The number of techniques will vary in terms of how many folks need. But then it becomes really about how can we keep you long enough to get you what you need to get better. And so one thing we'll often say at Big Health is that if we have someone who comes into our program touches it 100 times but doesn't get better, that's a fail. If someone touches our program three times but gets better, that's a win. And so as the teams think about remission, they really have these two main tools to think about. And so I'll start with retention one first, and that one is really about what psychologists call treatment formulation. The drivers, the reasons why you feel the way that you do, Those are some of the things that we're really trying to address. And the better we can match the techniques that we're teaching you with your underlying drivers for the symptoms that you're feeling, the more quickly we can actually bring you into remission or help you recover from that condition.

Can you break that down and give us an example? Like what would be an example of a driver for somebody?

Yeah, yeah. I'd pull this way, way, way back and say even some of these drivers go across different condition areas. So like imagine right now, Kristen, I'm talking to you. And if I were so stuck in my head about a conversation that I had this morning where I'm like, oh my God, I'm an idiot, I regret this. They probably are never going to talk to me again. So much so that I am not able to engage in this conversation. That is a driver that we would call that anxiety. Because I can't engage in this day to day thing if that happens at 11pm tonight and I can't go to sleep. That we would call insomnia. That is an example of that driver where you can start to imagine that the technique that you would actually teach someone for insomnia or for anxiety actually ends up being either identical or very, very similar. And so it's about rumination and it's about your racing mind. And so really we're trying to understand what are the things that are actually getting you to feel the way that you do. Another one could be catastrophizing. I think the colloquial term or exaggeration of this would be making a mountain out of a molehill. And so if you see something small, it's like, oh my God, this is going to have a major impact on the rest of my life. What if I die? That's another example of a possible driver. And so the first part of it is, yeah, can we better match those techniques if we don't need you to learn five techniques to get you better? And we've actually matched it so well that you only need two techniques. Great. The retention problem just got much easier. So we move on to the retention side of things. And that's where we're really trying to make sure that we deliver the things to you that will make a difference in your day to day life. And this is where I think it touches more on sort of traditional retention practices. And I would say that what we're doing here is nothing mind blowing. We really build everything off of operant conditioning. And so really think about what is that cue routine reward cycle that we can give to you. And one of the things that is really interesting about working in mental health is what those cues are. And so, you know, in the last decade or more at this point, maybe even a lot of people have talked about what those cues or triggers may be. And I think there's a lot of good thinking out there around negative emotional triggers or cues tend to be stronger drivers. And so a really fundamental one would be hunger. You go to your fridge or you open up doordash. But then we also talk about fomo. You open up, you know, a social media product. What's interesting about working in mental health is that we're in the business of negative emotions. And so actually every time you have that negative feeling, that's part of what we're trying to help you with? And so our entire offering, why we exist is built around these cues. So everything we're trying to do is when you have that feeling, can we get you to take on some sort of action, some sort of routine and give you some sort of reward for it? And again, you know, people think about rewards like badges and whatever. In this case it's relief. It's actually feeling like things are different. And so we're really targeting is as quickly as possible. How can we jump into that cue routine reward cycle so that the cue is you have this particular negative emotion that you feel might be the feeling of overwhelming, it might be the feeling of pressure or whatever it may be. And then for you to know a certain technique that you can use in that moment, and the reward is that you feel just a little bit better, just enough so that you would be willing to try it again the next time and maybe even willing to learn another technique that you can use in that cycle.

We are what we measure, right? One critique of tech is that most companies measure logins, or the number of times you open the app. So since logins are the key success metric, when companies try to increase, they tend to build apps that keep us coming back. In other words, they keep us addicted. Hello, TikTok, am I right? So what if instead we measured customer well being? This would incentivize developers to drive value to the user rather than just getting them to open the app. And that's what Sleepio is doing. In their case, this means measuring if people sleep more or feel better. But this could be easier said than done. How does Sleepio know if their users are feeling better or if the users are actually following their advice? Basically, what are the metrics Kelvin is measuring to assess well being?

This is a really important question for, well, I guess all behavior change, but particularly within health. And one of the reasons why I'm just so excited to be applying this into mental health, when I've worked on this type of problem for something like diabetes or hypertension, physiological conditions, the end of that feedback loop will sometimes require some sort of big action in the physical world. Getting a blood test, going to see a doctor. One great thing about mental health is that one of the key diagnostic criteria are clinically validated psychological instruments, which is really a fancy way of saying a questionnaire. And so the questionnaires have hundreds of thousands of data points and their specificity and sensitivity are in the high 90 percentage ranges. And so they are more than sufficient for us to use as a way of tailoring your program and then assessing your outcomes. And so that's a really long way of saying that in mental health we get that full feedback loop all within the app and we don't need to have a physical thing or deliver something to your house or whatever it is. So that is ultimately the goalpost. Now, of course, whenever you have sort of a North Star metric, good practice to have more proximal ones. And so for us, it's all about learning techniques and practicing techniques. And so the other things that we look at are the number of techniques that folks learn. And then we try to get measures of the number of techniques that folks practice. The first one, very easy because that's just usage within the product. And that's the thing that we look at the practice side. There are really two options. One is we have guided practice within the product. And so more true, especially for relaxation techniques, but also like exposure therapy. And so as we walk you through telling a story to yourself, but we also strongly encourage you to do this stuff outside of the app. And so that's where that is based on self reporting today. So in the beginning of when you come into our products, we will ask you like, oh, did you have a chance to practice any of these techniques? And we use that as a slight indicator toward this. But really the biggest one that matters to us is that clinical measure and whether or not you are ultimately improving.

That's nice. So you have to get people to take the survey in general, but then once you do, you're getting a really robust measure on how they're doing.

Exactly, exactly.

Okay, we're going to go into a few rapid fire things. It doesn't actually have to be rapid fire, but rapid fire just sounds. It sounds more fun and sprinty.

So we're going to answer them really slowly and give really long winded answers then.

Wonderful. I'll cut you off. Just kidding. So one idea here is that many times we hear about features that work, are there features that didn't work? So have you launched something that just didn't actually hit the mark and what did you learn and what did you do about it?

Yeah, I mean, this happens all the time. And so Tristan, you know, you know, I talk about this a lot in terms of wanting to apply a specific cognitive bias within a product and then knowing when to give up. Right. And so I'd say that the times things haven't worked are usually within those cycles where. And ultimately we did find a way to apply it, but the first few times didn't work. And even to try to be rapid fire about this, some of the stuff I talked about earlier of how to use friction and how to make folks feel heard, it's a delicate balance. And so I talked about successes where we've added more questions and we've actually gotten more people through, we'll do some stuff that is built around ultimately the Barnum effect or horoscoping that entire group of biases. And in trying to do that, we have inadvertently created additional decision points for users that then actually did create more drop off. So we did find this nexus of, hey, they felt more heard, but they still didn't stick around as long. And so that's where we just like rapid experimentation and iteration can get us through that.

Next question. How do you feel about sleep scores? I actually personally reveal my sleep is terrible and I tend to try some apps and they give me a bad score. I look at the number I try for a week, I get depressed and give up. And so it seems like this isn't as score based as all the other sleep interventions, but do you have a score and how do you feel about giving people numbers?

Yeah, so I'd say those are two slightly different questions for me. So the sleep score that we have for sleepio and then the equivalent for daylight we have is what's your anxiety type? Ultimately, both of those are engagement tools as a way of helping folks understand what might be driving some of their challenges and that there is help out there. And one of the biggest challenges that we have within mental health is and Kristen, I think you know the stat already is 7 out of 10 people with a mental health condition have not sought treatment in any way, haven't seen a doctor, haven't tried to see a therapist, aren't taking any medications.

Here Calvin's talking about something called low perceived need. A big reason we're so often slow to seek mental health treatment is we rationalize our condition with what is going on in our lives and convince ourselves we're otherwise fine. A single mother might say, I'm working two jobs, of course I'm going to be stressed. Or a high powered attorney might say, I've just made partner at the biggest law firm in the country, of course I'm going to have trouble sleeping. They're using the situations in their life to justify why they're feeling what they're feeling and why they don't need help.

A lot of those scores and these again, another use of the Barnum effect is really to help people feel like, oh, I am unique, but you've understood me and oh, you're telling me that there are these particular things I should work on. So that's where things like the sleep score really help. But even, even within sleepio, while we talk about the sleep score up front and then we do just a follow up with it, the program is actually built around that sleep efficiency measure that we were talking about earlier. And that's where that number can be really helpful because it's really concrete representation of the quality of your or how efficient your sleep is.

And it probably gives you Something to go back to and see if you've improved.

Exactly. Exactly.

At some level. It's a curiosity metric by which people are brought back to the app to see how well they've done.

Exactly. And all of those are built off of clinical measures as well. And there's a lot of value in presenting those to users upfront. But we take all that sort of holistically to try to figure out how we can get you the help you need.

You are unique, or at least one of the more unique people that I know in kind of combining the clinical and the behavioral science expertise. So if you could teach behavioral science something from your clinical knowledge, what would you teach?

That's such a good question.

Or you could go the other way around. What behavioral science could you insert into the clinical toolkit?

What I see a lot is actually, there's a lot of overlap. Similar concepts are talked about in both spaces and just discussed differently. And so I will be meeting with our clinical psychologist and we'll talk about something like, oh, this is what we call it in behavioral science. Like, oh, it's the same thing. I think maybe one of the concepts that we talk a lot about for clinical psychology is one that is really important but more amorphous. And maybe you would be able to guide me to something that is in sort of the JDM space is what would they call the therapeutic alliance? And so the therapeutic alliance is ultimately, and I'm going to get this imprecisely wrong. So for clinical listeners, I'm sure they will want to correct this is it's more about the relationship between the patient and the therapist. And how do you develop one of credibility? How do you develop one of trust? And so building up to things like doing sleep restriction. It's probably hard between two humans for therapists to convince someone to do that on day zero, but, you know, after you've met with someone a few times to build that up. And I'd say that's one of the amorphous concepts within the clinical psychology space. It's very heavily studied, and so there is a lot of structure behind it. But in terms of how we apply it directly into a digital product where there isn't a human involved, it's a bit more amorphous of how we build that credibility, that trust, that ability to challenge you and ask you to do things that we know are not pleasant.

So in behavioral science, we have a couple ways to describe what Kelvin is talking about here. One is the messenger effect, which is a phenomenon where we determine how much we Trust a piece of information based on who is giving it to us. There's also a concept called foot in the door, which means you're asking people something very small and then hope that they'll do something bigger for you later. Last rapid fire would be. You've talked a lot about personalization. When you're personalizing an app for somebody, how different are we? And I think this is a question that a lot of tech teams struggle with is in a perfect world, you personalize everything, and we just don't get the bandwidth or the resources to actually do that. And it's also kind of uplifting if we think that people are more similar than different. So there's kind of two angles to look at this.

First, to answer your question very directly, is the reason why psychology as a discipline exists is because there is something at a minimum, that is in common among all humans in the way that our brains work, in the way that we perceive the world around us. And I think one of the challenges for therapists is to take that expertise about an understanding of how all humans behave, but then apply it in a setting where the individual believes that they are, you know, a unique snowflake and that. That I am different than and than everybody else. And this is why it might be a good opportunity for me to dive into that, the Barnum effect a little bit more. And for those who aren't familiar, a lot of folks will call out if you talk about why horoscopes are so popular or personality tests. But when you personalize based on some attribute of the person and you make general statements, folks are likely to try to pull out the things that they feel like are the most relevant. And so even sort of generic profiles can be rated to be highly personalized. And so that ends up being one of the challenges for us, where the underlying mechanics, like a lot of the techniques I talked about, quite frankly, almost everybody who uses, like sleep restriction, is. Almost everybody will get that unless there's a reason not to get it. But what's really important is that relevance layer of how do we skin it so that we make it so that it feels much more applicable to you? And even as we're talking about some of these onboarding questionnaires, that's where that really matters. So we earlier talked about drivers, one of the earlier iterations of our onboarding flow. We basically just gave you a bunch of questionnaires, and we told you specifically what those drivers are that are likely causing or the result of feelings you have, but it did okay. And then we essentially took those same drivers, but we packaged it up into different anxiety types or different anxiety profiles, and it performed 23% better.

I love it.

That's great. So it's one of these things where, again, it's the same thing, but you present it in a way that helps folks see that personalization. What I think is wild in our. In our program right now is that if you think about the technology aspect of it, some of the areas that are technologically the heaviest to personalize, people perceive to be the least personalized. And some of the areas that are the least personalized, people call out frequently as the thing they love the most. And so I think, really trying to understand that balance is really important to being successful in delivering this type of therapy.

Basically, you want to feel seen, and it's not always feeling seen is the technical hard. I need to build an AI in order to do this. It's about recognizing a person's uniqueness at some level.

Exactly. And the reference thing you were saying earlier is that a lot of people have been hearing things that really suggest they haven't been heard. Again, like the relax, chill out. And it's like, no, it's not about chilling out. It's actually about something entirely different.

Kelvin, help us figure out where digital mental health is going. There's this really lovely example from technology adoption. It's called the Story of Kelly Gang, and it's the first feature film ever. And in every scene, surprisingly, the camera stays in the same place. And the question is, why? Because in hindsight, you'd say, just move the camera. And so for that reflection, the question is kind of, where are we at now with mental health? How do we get mental health apps to basically maybe be more smart? So you're taking advantage of all the digital tools that we have out there versus, you know, kind of the. Some of the mood tracking and journaling. And by the way, I'm not saying you do just mood tracking and journaling. This is more of a reflection on kind of where the state of mental health apps are versus yours.

Yeah. Yeah. So I'll give two parts of this answer. I think the first part might be a little more boring, but is, I actually think, really critical for the space. I'm really happy to see the direction that mental health has taken over the last year, and both from a demand perspective. And of course, prevalence has increased, which is devastating, but also the perception and stigma has reduced, and so people are more willing to reach out. But then decision makers at health plans, practitioners, pharmacy benefits folks, these people are also starting to evolve their views of digital products. And so the first part of my answer is actually more about business models. We are seeing a very clear separation into two spheres of more on the wellness well being side where use language like resilience and stress and then more on the conditions and the symptoms of the conditions side of things. And if you go back to how I was talking about cognitive behavioral therapy, in order to get folks better, we don't need to keep folks around for a very long time using our product. And so a question I often get is, if it's a product manager, like what is your daily actives or monthly actives? But it's like actually no, like when people are done, we count more how many people have remit, how many will have recovered. And the only reason that I have the luxury of doing this is because we think of ourselves as a digital medicine. And so in the same way that your physical medicine, you get your prescription, you fill it and that's like when the billing happens. And so for us, like once you're actually using it, like that's good. And now we have to prove to the people that, that have paid for it that this is a good thing to continue to pay for for everyone else who needs it. And so I think we have this big luxury of not having to worry about monthly subscriptions. How do we keep you around for one more month? Can we give you a discount? Can you pay for it one year in advance? But our job is to get you better. I think having that flip would already address some of the stuff you're talking about on mood tracking and other things that have more of a daily aspect to it. And that's just how you would be using it, but are maybe not necessarily the highest leverage way of getting people better. So that's the first part of it. Second part of it is actually more on the collection side of things I'm really excited about. There's still a lot of work going on to essentially get to what I was talking about of these clinical questionnaires. But to be able to understand how someone is doing based on some of their passive data. And so that could mean things in wearables or ambient computing. But it's also some folks have looked into how often are you opening up your text message app? How often do you hit the backspace button when you're texting someone? Are you like self correcting yourself? Those can become really interesting signals to get a better sense of where you are on that anxiety curve that I was talking about earlier. Because if we can more precisely get a sense of when you're in that magical after after phase or the after the hurricane, as you put it, I think we would be much more effective in being able to land these messages, teach people these techniques so that when they're in that peak moment of high motivation but lower cognitive ability, they have stuff in their back pocket that they can pull out. And so I would love to be able to get a little more granular and precise with understanding the context of someone's life.

That was Big Health Chief Product Officer Calvin Kwong. So aside from our adorable and hilarious banter, there were actually some really cool takeaways from our conversation. The big one for me was that he thinks mental health apps have made incredible strides over the last several years and amid real improvements in people's lives. The challenge going forward is what we talked about earlier, how to reach potential users and convince them that now is the right time to consider their mental health. Our team recently did a study that asked people to either call in to volunteer at a hotline that offered mental health services or actually get the help themselves. In both cases, the only thing promised was a conversation with a peer. It was just a different way to ask a question and get people to opt into a conversation with someone else. So what happened? Only 8% signed up to receive help, while 16% signed up to volunteer. People were twice as likely to engage as volunteers. Participants also said they'd spend Significantly more time volunteering 73 minutes versus receiving help 22 minutes. Those ready to volunteer were prepared to spend over three times as long doing so. Why? Our hypothesis is that asking for help may signal something socially undesirable that we need help. It's possible that this negative social component may impact the likelihood of asking for help at all. This is the mental health that we need to crack, getting people to raise their hand and start treatment. Thankfully, it's the nut that Calvin and team are attempting to crack and I'm optimistic for them and for the future of mental health care. The Science of Change podcast is presented by Setsale act on the moments to lead to a sale. Visit them at Setsail co or on LinkedIn to learn more about the world's number one revenue execution platform. This podcast is produced by me, Kristen Berman and Studio Pod Media. Our Executive producer is Rachel Roberts and all episodes are written by Jack Ewer.