7 ms·

Quirk – Open-Source Cognitive Behavioral Therapy

346 points by flaque 8y ago

wolco 8y ago
Great idea.
modi15 8y ago
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.
- flaque 8y ago
  > 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.
  - dfrage 8y ago
    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.
onesmallcoin 8y ago
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
- DanBC 8y ago
  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.
- tastroder 8y ago
  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.
RootKitBeerCat 8y ago
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
navs 8y ago
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.
MehdiHK 8y ago
Just read your design goals. Thank you for doing this!
sulkie 8y ago
Thank you. Would you mind publishing it on F-Droid?
- prophesi 8y ago
  +1 to this. I'd also be overjoyed if the app could be locked with a password/fingerprint.
- flaque 8y ago
  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 :(
atomical 8y ago
For anyone who wants a book check out Feeling Good: The New Mood Therapy by David Burns.
- dfrage 8y ago
  Please don't downvote this suggestion, for decades Burns' book https://www.amazon.com/gp/product/0380810336/ 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.
  - flaque 8y ago
    Also agree! This was the book that originally turned me on to CBT. It sounds super cheesy, but everyone should read that book.
  - therealdrag0 8y ago
    > 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?
    - flaque 8y ago
      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.
DavideNL 8y ago
> "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.)
- flaque 8y ago
  This is a good point, will do.
DvdMgr 8y ago
In the beginning of the readme the link to the Wikipedia page for CBT points to the section about declining effectiveness, is this intended?
- flaque 8y ago
  Lol nope! Good catch thanks!
cassowary37 8y ago
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.
- flaque 8y ago
  Thank you!!
- sizzle 8y ago
  What CBT techniques have you found the most successful in your experience/practice? Thanks!
- zaphirplane 8y ago
  As a psychiatrist what about hn makes you follow it / interests you ? There was also a heavy vehicle mechanic which was also surprising
superasn 8y ago
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
- wodenokoto 8y ago
  Really? That example looks more like a way to pile guilt on yourself.
  - epaga 8y ago
    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.
  - superasn 8y ago
    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
    - zaphirplane 8y ago
      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
      - superasn 8y ago
Gerrish 8y ago
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.
- TomMarius 8y ago
  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?
  - endymi0n 8y ago
    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).
  - Angostura 8y ago
    An example on iOS being?
    - TomMarius 8y ago
      I didn't consider that, sorry.
- Angostura 8y ago
  Agreed. Probably a bit of a dealbreaker
- flaque 8y ago
  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-e1X3Ycm-Mb/view?usp=drivesdk https://drive.google.com/file/d/1snJ-lyZwAWkrF9c2V0V0p-e1X3Y...
geekamongus 8y ago
My therapist wife was quick to exclaim how great this was. Nice job!
cjw3 8y ago
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.
- fxfan 8y ago
  Please share!
- Scarbutt 8y ago
  How do you strengthen your eyes?
pandatigox 8y ago
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?
codemati 8y ago
Great idea. Are you open to PRs? This is kind of project I would love to work on.
- flaque 8y ago
  I am! Though note the project is kept purposefully small in features.
lkhatter 8y ago
This will be helpful to a lot of people! thanks for sharing!
ntlk 8y ago
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.
- flaque 8y ago
  Ah, yeah! Data is only stored on the device. It’s never sent anywhere.
jokowueu 8y ago
GitHub says there is an Android version but I can't seem to find it
- flaque 8y ago
  Does this help? https://play.google.com/store/apps/details?id=tech.econn.quirk https://play.google.com/store/apps/details?id=tech.econn.qui...
  - trendoid 8y ago
    Is the android version less stable than iOS? I ask because on the website https://getquirk.app/ https://getquirk.app/ , you haven't mentioned it and avoided putting link on Github yet. Thanks for working on this!
    - flaque 8y ago
      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
      - vanderZwan 8y ago
        I really appreciate that you don't advertise an unstable version just yet, given what this application is for.
jdorfman 8y ago
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.
- flaque 8y ago
  > 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.
- DanBC 8y ago
  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.
theprotocol 8y ago
I really really appreciate the detailed writeup on the design/engineering. Thanks for doing this!
zuzuleinen 8y ago
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?
deleted 8y ago
[deleted]
raihansaputra 8y ago
Any chance for you to publish it on F-Droid?

346 points by flaque 8y ago

Great idea.

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.

flaque 8y ago
> 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.
- dfrage 8y ago
  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.

onesmallcoin 8y ago

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

DanBC 8y ago
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.
tastroder 8y ago
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.

RootKitBeerCat 8y ago

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

navs 8y ago

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.

MehdiHK 8y ago

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

sulkie 8y ago

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

prophesi 8y ago
+1 to this. I'd also be overjoyed if the app could be locked with a password/fingerprint.
flaque 8y ago
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 :(

atomical 8y ago

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

dfrage 8y ago
Please don't downvote this suggestion, for decades Burns' book https://www.amazon.com/gp/product/0380810336/ 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.
- flaque 8y ago
  Also agree! This was the book that originally turned me on to CBT. It sounds super cheesy, but everyone should read that book.
- therealdrag0 8y ago
  > 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?
  - flaque 8y ago
    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.

DavideNL 8y ago

> "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.)

flaque 8y ago
This is a good point, will do.

DvdMgr 8y ago

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

flaque 8y ago
Lol nope! Good catch thanks!

cassowary37 8y ago

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.

flaque 8y ago
Thank you!!
sizzle 8y ago
What CBT techniques have you found the most successful in your experience/practice? Thanks!
zaphirplane 8y ago
As a psychiatrist what about hn makes you follow it / interests you ? There was also a heavy vehicle mechanic which was also surprising

superasn 8y ago

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

wodenokoto 8y ago
Really? That example looks more like a way to pile guilt on yourself.
- epaga 8y ago
  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.
- superasn 8y ago
  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
  - zaphirplane 8y ago
    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
    - superasn 8y ago

Gerrish 8y ago

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.

TomMarius 8y ago
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?
- endymi0n 8y ago
  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).
- Angostura 8y ago
  An example on iOS being?
  - TomMarius 8y ago
    I didn't consider that, sorry.
Angostura 8y ago
Agreed. Probably a bit of a dealbreaker
flaque 8y ago
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-e1X3Ycm-Mb/view?usp=drivesdk https://drive.google.com/file/d/1snJ-lyZwAWkrF9c2V0V0p-e1X3Y...

geekamongus 8y ago

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

cjw3 8y ago

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.

fxfan 8y ago
Please share!
Scarbutt 8y ago
How do you strengthen your eyes?

pandatigox 8y ago

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?

codemati 8y ago

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

flaque 8y ago
I am! Though note the project is kept purposefully small in features.

lkhatter 8y ago

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

ntlk 8y ago

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.

flaque 8y ago
Ah, yeah! Data is only stored on the device. It’s never sent anywhere.

jokowueu 8y ago

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

flaque 8y ago
Does this help? https://play.google.com/store/apps/details?id=tech.econn.quirk https://play.google.com/store/apps/details?id=tech.econn.qui...
- trendoid 8y ago
  Is the android version less stable than iOS? I ask because on the website https://getquirk.app/ https://getquirk.app/ , you haven't mentioned it and avoided putting link on Github yet. Thanks for working on this!
  - flaque 8y ago
    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
    - vanderZwan 8y ago
      I really appreciate that you don't advertise an unstable version just yet, given what this application is for.

jdorfman 8y ago

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.

flaque 8y ago
> 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.
DanBC 8y ago
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.

theprotocol 8y ago

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

zuzuleinen 8y ago

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?

deleted 8y ago

[deleted]

raihansaputra 8y ago

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