We’re talking with Evan Conrad — for most of Evan’s life he has suffered from severe panic attacks, often twice per week. Eventually he stumbled upon a therapy method called Cognitive Behavioral Therapy, or CBT for short, and saw positive results. This led him to create Quirk, an open source iOS app which allows its users to practice one of the most common formats of CBT.
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Evan, we first met via e-mail back in October… You were trying to solve some podcaster problems, and you e-mailed me recently, and it seems like you’ve been busy solving some of your own problems since then…
You have this app called Quirk, which is for cognitive behavioral therapy (CBT). We’ll get all into that, but first, tell us about yourself and what you’ve been up to before Quirk.
Cool. For the good portion of my life I’ve had pretty severe panic attacks. About twice a week I would have an attack, and it would be like about an hour to two hours. And if you’ve ever almost been in a car accident and you’ve swerved around and then you get this huge rush of adrenaline in your chest, and your whole body feels really warm, and then you start to feel kind of like you’re afraid, but it’s this extreme physical sensation, if you mix that with the same feeling that you would get after watching a horror movie, where you think that everybody behind you is about to murder you because you’ve just watched a horror movie - if you mix those two things together and then you stretch that out for an hour, that’s basically what a panic attack is, or at least what it feels like. I would have these twice a week.
Would they be triggered by things, or does it just happen on a schedule? I’m not sure how this works.
Sometimes they’re random. Sometimes they just happen. And then sometimes they’re specifically related to disease and vomiting, that’s the thing that triggers them generally.
So the panic is typically like afraid of being somehow deathly ill, or being about to vomit, or some particular thing related to that. Most of my life I’ve been cycling through different thing after different thing, of different types of treatments. For a while I was on SSRIs, which are medication you can take for it, and seeing different doctors about it, and trying to figure out ways to do it… [00:04:05.03] Then in about 2018 I went and I saw a real therapist that I hadn’t actually seen before; I’d typically been more on like the medical side… And I tried this thing called cognitive behavioral therapy.
Cognitive behavioral therapy is based on the premise that depression and anxiety and panic aren’t a physical thing that you’re born with. It’s more like – instead of it being a hardware problem, it’s like a software problem, and it’s something you can fix. What cognitive behavioral therapy has you do is it has you record thoughts that you’re having, and then find effectively logical fallacies with them, and then write down a challenge to that thought, and then change the thought into something else.
For example, if you just got out of an interview and you think “Oh god, I took too long to answer that question. That means that I’m going to fail this interview, and if I fail this interview, I’ll never get a job anywhere. And if I never got a job anywhere, I must be really bad at this programmer thing… And if I’m really bad at this programmer thing, I must have wasted all this time learning all of this, and that means I’m dumb…” And if you think this way, it’s called a negative automatic thought. It’s something that’s happening, that your brain is just cycling from thing to thing, and each individual step feels really logical at the time, but it’s illogical in the first step, and each step is this logical leap to the next thing…
So what cognitive behavioral therapy has you do is it has you record these, and write these down, and then individually challenge them. So it’s like “Is it actually true that if you took to long to answer a question in an interview, that you would actually fail that interview? And is it actually true that if you fail this interview, you’ll fail all the other ones?” Because surely, if you’re failing one whiteboard question, that gives you practice, so then you can do better in all the other whiteboarding sessions, and over time you’ll get better at interviews.
And even if you’re not gonna get a job anywhere, is it really true that it’s so absolutely important that you must be a programmer? Lots of people aren’t programmers, and it’s actually okay to not be a programmer. And there’s all of these steps that you can take in each thought, that checks whether or not it’s actually true. Then when you do this enough, your brain kind of just does this for you. But one of the things about this is it requires a lot of writing.
Typically, the way a regular therapist might do this is they give you a workbook. It’s a print-out copy of a bunch of different worksheets that you’re supposed to fill out on the fly. And if you’re filling out these things on the fly, what happens is people don’t actually do it, because people will have this thought, and they’ll be in public and then they won’t take out their workbook, and a piece of paper and a pen, and actually fill out all the columns in the thing. So a lot of people try this, and then it doesn’t actually work for them, because it’s this big, bulky thing that you have to do all over the place.
So some people solve this with some apps - there’s some apps that you can use. Quirk is basically one of those. But its main goal is to be the best, and the freest. I mean, a lot of them are free.
I like that, freest.
The openest-sourcest… [laughs] It’s an open source version. It’s also truly free, and by truly free I mean it doesn’t have any in-app purchases, it doesn’t have any ads, it doesn’t collect your data and sell it somewhere. It’s truly free, not free as in like “free, but it has a $200 in-app purchase”, or something. It’s really free.
No cost, yeah.
And it’s doing well, it’s helping people.
There’s some things that you mentioned there that I think are interesting; you were talking about essentially the way you remap truth, right?
And there’s this term in psychology that is essentially that neurons that fire together, wire together. What that means is where your attention and your energy and the things you think about, essentially, what you feed is whatever you focus on. That’s gonna eventually become some sort of truth to you.
[00:08:09.07] That’s kind of interesting… And the fact that the more you dwell on negativity, the more negative you become. Not because you’re a negative person, but because the way the brain works is that the things you totally focus on, the truth you start to essentially determine, becomes true… You know?
Yeah, absolutely. One of the problems with a lot of negative thoughts that people tell themselves - and this is something that cognitive behavioral therapy specifically tries to treat - is that a lot of the things you tell yourself become self-fulfilling prophecies.
So if you’re concerned that you’re not gonna pass these interviews, and then you don’t do anything about it because you feel so bad about it, you might end up not passing these interviews. And if you’re caught up so much in the fear of something, it becomes a large portion of you. At the moment I don’t have panic attacks anymore. It’s been three months since my last one, and three months since the one before that…
…and I used to have them every two weeks, so… It’s pretty great. But the thing that’s most different is the amount of your life that you get back.
My gosh, yes.
And I think I didn’t expect that.
So let me identify with you real quick, because Jerod mentioned to me behind the scenes here in our Slack - we have a DM going on pretty much forever - he reminded me, and I’m aware of this as well, but I’ve had similar public concerns. It was agoraphobia, or a variation of it, a very light level of it, where I couldn’t be in a theater. I love movies; Jerod, you know I love movies…
I know it.
And I love going to the theater.
Even bad movies.
Even bad movies, yes, sir.
And I was always at home in a theater, but it was after some trauma, it was after a family member passed away unexpectedly… I had started to get similar things that you’re talking about, little panic attacks that would happen. The first one happened at church, at the end of church. I was like “I am literally sweating bullets here. I’m super-hot, I don’t know what’s going on.” I thought I was just hungry, or my sugar levels were off, but… Out of nowhere, nothing triggered it. Then it happened in large crowds, I couldn’t take being in large crowds. I couldn’t go to – my wife loves Broadway, and I don’t know if you’ve ever been in vaulted seats in Broadway, but they’re pretty tight. They wanna pack a lot of people in.
So I would get in there and I would think “Where is the exit?” I would have a strategy for like “I know I’m gonna feel panicked” the entire time we went and saw something, and I couldn’t even pay attention. She’s enjoyed herself. She’d sit right next to me, enjoying herself, and I can’t for the life of me at all even think about anything besides getting out of there, the whole time. I’m talking like an hour and a half, plus intermission…. And it’s terrible. It’s terrible.
And what I found was similar. I didn’t go through CBD, or C– CBD… I’m on a different wavelength here. [laughter] That might actually play some role here at some point.
That could help, too.
That could help.
That is a common joke. I live in California. CBD is very legal. I mean, I guess it’s legal in lots of different places.
It is, yeah. It’s been legalized. CBD oil by itself, aside from THC, is legal.
So they’re actually using a lot in different therapies, and stuff like that…
But the thing I was trying to drive home to was that my truth had become that when I’m in these scenarios, that had been where I struggled, I would essentially tell myself some sort of lie, like “I’m gonna die” or “I’m gonna feel a certain way”, and it would become true. So we’re all struggling, we’re all trying to seek out some sort of truth. So my method, which was not exactly going through cognitive behavioral therapy - it’s probably my own variation of it - was this thing… It’s admit the struggle, because we all struggle, identify the lie, and seek the truth. So if every time you’re in these scenarios, it’s like, there’s something you’re struggling with; there’s some sort of lie you’ve told yourself, and you’re believing it, so identify that lie. What is that lie? It’s probably what you’re doing with this application or this process of CBT… And then you’ve gotta seek the truth, which is not having panic attacks, not feeling like you’re gonna die in the theater, or something like that.
[00:12:05.22] Yeah. Your comments though on always being afraid of the panic, and that ends up fueling the panic itself - it’s so absolutely true.
Yeah. Self-fulfilling, for sure.
Yeah, it’s self-fulfilling. It’s what keeps people in a cycle of panic, and a cycle of anxiety. The thing itself becomes the thing that you’re afraid of. I remember I did that all the time. It’s so true.
It would even happen to me – I can remember two occasions when I was driving… My wife had to go out of time, and I had to drive her down to the – we have two airports here in Houston - the IAH International Airport, and Hobby, which is in South Houston. Hobby is an hour away from us, so I knew I had a long drive… I knew we were running late, I knew she was frantic trying to get out on time, and right as I started to drive, I had one of these panic attacks… So the entire time I’m driving, all I can think of - and I’m in traffic - is “How can I get out of here?” It’s almost like being trapped.
And that’s how I felt, I felt trapped. I’m like “I’ve gotta drive my wife safely to this airport, I’ve gotta be there on time, I’ve got all this stress”, and the moment I dropped her off, I was able to calm down and it all resolved itself… But for that hour - man, I felt like I was in a coffin. It was terrible.
Right. And it’s because you’re just about to do something, and this would be the most inopportune time for it to happen. And that makes it worse.
Yeah, it’s terrible. It’s like “Don’t happen now…!”
Yeah, like “Don’t happen now.” This is the worst time for it to happen, which then makes it the time that it happens.
Do you think this is similar to habit formation though?
Because that’s kind of where I resolved some of my issues. I started to determine what was queuing these things; it was apparent whenever I was in public or in certain scenarios that this thing could potentially queue itself up…
And there was a natural response, which was either self-fulfilling, like we’ve been talking about, or it was natural, and it really was the truth, I was gonna have some sort of attack… And then obviously it would play itself out. Do you think it’s habit formation and change? Considering you’ve been through cognitive behavioral therapy, is it similar to habit formation change?
Yeah, psychologists call it cognitive restructuring, which is basically where your brain kind of rewires itself. It’s similar to what you were talking about before.
The neurons that fire together you mean…
Yeah. A lot of what you can do and what really helps is taking the moment where you feel like you’re having some sort of stress or anxiety, and then using that as the queue for why you’re stress and anxiety is illogical and wrong. So if you can use that as like the trigger for your habit formation, it’s really effective. At least that’s what helped me a lot. Anytime I felt that flush of adrenaline, and that immediate fear, that was a good sign that whatever I was worried about was probably wrong… Because 99% of the time that I ever had that, there just wasn’t physically anything wrong.
Before, your habit would be you get that queue, which is the immediate fear. And then you think like “Oh, crap! This is such a bad time for this. I can’t have this right now”, and that makes it worse. So what you’re doing is you’re taking that fear, and then you’re using that as the trigger, and then your response to that trigger is more fear, it’s the buying into it; you’re agreeing with it. And if you can take that fear and then use that as the trigger to disagree with it, that’s what unlocked a lot of change for me. Your experience sounds so similar to mine though. I think it’s the experience of a lot of people.
[00:15:47.02] If you’re comfortable with sharing this, have you identified anything else that’s wrong with you? We’re talking about mental health, mental concerns, something that’s in the brain, but what we forget, or we don’t know, because - hey, we all have brains, but we don’t know what they are, or how they work… They call it brain science, but it gets really geeky and you’re like “Well, I don’t need to know about that, I’m not a doctor. I don’t need to know about how my brain works.” But what we don’t realize is our brain is connected to so many other things in our body - our gut, our heart… Obviously, our nervous system doesn’t just begin with the brain stem and go up to our brain; it’s other things.
For me, I learned that my problems that I face with what I’ve shared here were not just simply mental health problems. They weren’t believing this lie. It was connected to my thyroid, connected to my diet, connected to other things… So it wasn’t just simply a “Hey, I’ve got a broken brain, and that’s just it.” What was it for you?
I don’t know. I don’t think I ever found anything particularly physically wrong… And that’s the thing that’s the craziest about it.
Do you have a good diet?
Yeah. I mean, I have a perfectly fine diet… I do run a lot, but I ran a lot beforehand too, so… It’s honestly just breaking that cycle, and recognizing when particular thoughts are causing your moods, and then using that to break the cycle.
I’m fortunate enough that I haven’t suffered from this circumstance. I’ve definitely had thoughts that would begin to unravel. It sounds like what you’re describing is where you’re basically building a straw man. You have one conclusion which may be truth-ish, it may have some grounds in reality…
And then you build on top of that, and you conclude on top of an assumption. Maybe that assumption has some grounding in reality, but the one you concluded on top of it has less grounding. And then the next one has less and less, until you are panicking over something that - like you said - is falsey.
And it sounds like this CBT, this process that you go through, is a way of short-circuiting that pattern. You’re cutting it off before you get to the stage at which it starts to take over. Is that a fair characterization of what you’re saying?
Yeah. And one of the things I’m realizing from Quirk is that you don’t need to be diagnosed with a mental health issue for CBT to be effective for you. In fact, a lot of the problems in the tech industry, or people having impostor syndrome - impostor syndrome is a great example of where this is just a common thing that happens to people, where they get some thought in their brain and it may not be correct or logical, but it spirals, and they start to think about it all the time, and they start to think like “I’m not good in this particular point” or “I can’t do this thing” or “That makes me bad here.” And you don’t need to be having severe panic attacks to be benefitted from cognitive behavioral therapy.
Evan, like you said, you don’t have to be diagnosed with anything to try CBT. It may benefit lots of different people.
Help us understand what that looks like. Maybe I’m interested in giving this a try, even just to stop some of my thoughts that tend to unravel. What does try CBT look like? How do you do it?
So you have a couple options. If you just want to do the easiest version, there is a book that you can get; that’s the book that popularized CBT, and it’s by David Burns. It’s called “Feeling Good: The New Mood Therapy.” It seems really self-helpy, but it’s actually the book that popularized CBT. It was written in 1980’s, and it still holds up as quite a good book for just if you want a good overview and understand how to do it. And if you want to actually implement it and try it, you can try Quirk.
Quirk is designed to give you a little introduction of how you do it, and it’s got a help screen and it teaches you how to do it… And then if you’re really dealing with something that’s either life-threatening or dangerous, or just you really feel like you need actual help, I would definitely recommend going and seeing a therapist, or a psychiatrist, or just anybody in your area. Absolutely.
Some bullet points from the publisher’s summary - at least on Audible.com - is pretty interesting for this book… “Recognize what causes your mood swings. Nip negative feelings in the bud. Deal with guilt, handle hostility and criticism, overcome addiction to love and approval, build self-esteem, feel good every day.” It’s just some takeaways, some anticipations of what you may encounter as you read or listen to that book.
I should also mention that CBT is like this de-facto standard. It’s not like some sort of wishy-washy self-help mantra, which is sort of what I had assumed it was beforehand. This is an extremely evidence-based tool, and it has been one of the most effective treatments for depression and anxiety for 30-40 years. And it’s not like it’s just an effective treatment, it’s like the gold standard treatment. There’s literally a study that calls it the gold standard. It’s a meta-study that reviews 200 other studies.
If you’ve gone into any therapist, it’s almost certainly what they’ve tried, just the first thing out of the gate. They might have called it a couple different other things. Sometimes they call it the Three Column Technique, or Catch It, Check It, Change It; I think that’s the other term. This is the first thing you should try if you’re really suffering with something, or if you’re just dealing with your own issues. This is the first thing you should try.
Well, the good thing is it’s self-initiated.
And what I’ve found at least, as I dug into this… I got into this stuff, this interesting perspective of brain science and behavioral therapy by way of being really interested in user experience, which, Jerod, the [unintelligible 00:23:04.19] is right up our alley for that reason. It’s like, behavior economics, behavioral therapy, true brain science, neuroplasticity, neuroscience - those are all really interesting things, but what you end up finding is that, at least just general people, they feel like its not their territory. Just because it deals with therapy, or their brain, or something very scientific-sounding, that they can’t be accountable to themselves. They need some sort of professional to solve all their problems… And it’s true, too.
To get over certain humps, you definitely need to go see professional help; this is not an advocate of saying “Hey, you can solve all these problems on your own.” But the point is that a lot of this is very approachable to everybody… And the first step really is just admitting that there is a struggle, and start to identify, which is what CBT does - identify the things that you’re struggling with and how you feel about those things… And then that’s how you begin to remap your brain, so to speak.
[00:24:01.26] Yeah, absolutely. I think if you dig into it, almost everybody will find a place where this is useful for them… Because the experience of being human for most people is just dealing with the way our brains lie to us, and the way you can kind of cycle on some thought; and that’s just normal. That’s what everybody feels, to varying extent, and that can get really out of hand, in which case you should definitely see a professional. But it’s also just common.
What’s interesting too that you mention there - I’m not sure how you worded it, but essentially what it made me think of was whether or not we can trust our memory… And Jerod, you can maybe help me out here, if there’s ever been a time where you’ve recalled something one way, and your wife, and/or friend/brother/sister whatever recalled it a different way… So you were both there during the experience, whatever it might be… But how often can we truly trust our brain’s memory? Because it requires so much stuff – like, your autobiographical memory, being able to understand that you’re in the present, past or future, for example, and all these different factors that begin to weigh in on whether or not our memories are truly true, meaning that’s how they actually worked out.
You can see in the courtroom, where it’s fairly difficult to two eyewitnesses to agree on something that happened. Even take perspective out of it just on the facts of what happened, just the memory aspect of remembering exactly something that happened… It’s so difficult that you can’t get two people to agree. And in fact, we have jokes - if they do agree completely, 100%, on everything, they’re probably lying… Because that’s how weak our memories are to the details of things.
Let’s talk about Quirk a little bit. I’m looking at the UI on the homepage, quirk.fyi if you’re interested in the app right now. Of course, it’s in the show notes if you wanna just click on the link. And the UI for this, that you have displaying in the anime GIF here, or the video, is basically you have a thought (which is a text area), what’s going on - this is where you type the thought that you’re having. I assume that’s the “Catch it” - you’re catching your thought right there. And then you’re checking it… So underneath that you have the cognitive distortion - you’re going to attach one or more cognitive distortions to that thought. This is really the process by which you’re judging it, right? You’re saying “What kind of a thought is this that I’m having?” And there’s a whole bunch of these distortions… Could you help us out a little bit on some of these? Because there’s all-or-nothing thinking, there’s catastrophizing, there’s emotional reasoning, there’s fortune-telling… I’m assuming these are official CBT terms, labeling mind-reading, and so on…
Do any of these need further explanation for somebody who has downloaded the app? Or maybe this is described in the app and it’s just not on this page right here… But how do I know what’s what? What’s “other-blaming”, what’s “over-generalization” etc?
They’re definitely described within the app. There’s a help screen that you can go through and check through that… And I definitely recommend to anybody who’s trying it out to do that. But all of these distortions - they’re effectively logical fallacies. One of the problems that I had when I was making these is that people kind of forget which ones are which… But they are a set of things that psychiatrists have determined that these are the ones that most likely cause people’s problems… And it’s often that people don’t realize when they have this sort of logical fallacy of cognitive distortion in their thoughts that’s causing that problem.
One of the things Quirk tries to do is it’s very intentional about the branding of cognitive distortions. Every cognitive distortion has an emoji, and every emoji is the same emoji for wherever you go. On the website, that emoji follows every usage of the term of any cognitive distortion. Catastrophizing is the head-exploding emoji, and on the app it’s the same way; in every header, it’s the same way. It’s there to try and give you a visual understanding of it, and to try and make sure that you remember it… Because that’s one of the biggest problems with cognitive behavioral therapy, at least in Quirk, that people don’t realize this..
[00:28:04.02] There’s a lot of terminology and stuff that you have to do to kind of get into this and to understand it… But it’s all this stuff that you have to do, at the same time that you’re going to the app with a serious issue - like, your brain power is already at its maximum capacity, because by definition, you’re using this app at a really difficult time. So part of the app’s job is to get you to the place where you need to be to understand just enough, so that you can record your thought and get to a more mentally-healthy spot… But it has to do that at the same time that it’s competing with other parts of your brain power. So Quirk has a really big focus on being very lightweight… Because if it’s too heavy and tries to do too much, you won’t record anything. It will have the same problem that worksheets have, which is people pull them out and then don’t actually do anything; or they don’t pull them out at all, because it’s very “a thing” that you have to do.
I could imagine people will have these kind of thoughts when driving, maybe when out with friends… Especially with driving, I would think, it’s probably very difficult. We all know the texting while driving problems that are causing crashes around the world. Please don’t Quirk while driving. [laughter]
Yeah, don’t Quirk while driving.
Pull over to the side of the road… I mean, what’s the advice there? Maybe you need a dictation. Maybe it’s built into the OS, or something… But I could see where that would be difficult.
I think you can do it with the OS, but definitely don’t Quirk while driving. Quirk’s goal in a lot of the design of it - this topic is so wildly serious, and really important for so many people’s lives, and it’s a very important, serious topic… And yet the branding and design of Quirk is very derpy, and really kind of silly. And that’s on purpose.
Well, even the word is kind of a funny, light-hearted word. Something’s quirky, you know…
Yeah, it’s the quirk – Quirk is called Quirk because it’s kind of like a little silly, and Quirk’s little mascot is these three little cute-looking derpy things… And that’s on purpose, because every other mental health app comes to you – or any mental health tech in general, it comes to you with this very serious user interface, and very serious look, and it says “Look how important and medical I am, and look how serious I am”, and it’s coming to you at this point where you’re thinking these really awful thoughts… And those thoughts are what you consider at the time to be the most important and most serious thing. But part of cognitive behavioral therapy is recognizing that the thoughts you’re thinking aren’t as serious and aren’t as weighty and important as you think of them at the time. Because the reason why they’re causing you so much distress is because you’re putting so much emphasis on it.
So Quirk’s job is to kind of try and bring that emphasis down a little bit, and make you realize that “Whoa, whoa, whoa… Hold on. This thing you’re wildly freaking out over, this thing you’re quite panicking over - that’s not as serious as you think it is.” But at the same time, it is very serious, because we’ve built this whole app just for this; this is a real big problem, that you paid to go see a therapist about, and causes people very significant portions of their life… But you have to reconcile that with the fact that the way to get better is to realize that it’s not as serious as you think it is. And that’s really tricky.
It’s kind of like talking somebody off the ledge, and the ledge may not be the true ledge, just more or less this in-the-brain ledge that you’re taking the serious thing, so to speak, as you’ve just mentioned. It’s almost like the first line - if you lack another human being near you to have a relationship with and to remind you of your truth, which is a huge part of your relationship… Because what you believe, Evan, and what I believe about what you believe may not be the same, as we just kind of mentioned about how we trust even our brain’s memory…
[00:32:09.02] Your perspective on the scenario and my perspective on the scenario - you may be in freak-out mode, and I’m like “Dude, chill out. You’re catastrophizing, or you’re fortune-telling”, or whatever the application does. So a human might do that, and what you seem to be doing with this application is to supplant a piece of technology that has potentially human characteristics, that says “Hey, you’re not actually on a ledge. You’re labeling, or you’re mind-reading.”
Yeah, it’s exactly that. It’s exactly that. It’s replacing a little bit of the human touch. That’s a really good point.
This leads me into a potential direction for Quirk that could be catastrophizing, it could be terrible, but it might be kind of great… So I’ll throw this out there and see what you guys think, which is - you’re kind of removing the human element, you’re kind of replacing what would be a therapist helping you identify what’s wrong with this thought, or a friend, or a family member… And I’m thinking, what if there WAS community? What if it wasn’t so cold, and you had some sort of way of anonymously submitting your thoughts to the community? Because over time, I think it sounds like CBT - you get better and better at it, and you get probably pretty good… Everybody is more objective with somebody else’s thought than with their own, because it’s inherently subjective; you’re the subject of the thought. What if you could submit it for other people to apply their idea? They could identify the cognitive distortions in the thought, and you get some real-time feedback from others.
That is interesting. That is not a bad idea. That is quite interesting.
Alright… I thought you were gonna say “That’s a terrible idea.” [laughs]
Most ideas Jerod has are not generally terrible.
Thanks, Adam. I’ll take that as a compliment.
It’s a very nice compliment.
Yeah, it was meant to be a funny compliment, yeah.
It was very careful.
“Generally” good ideas. Very good.
[laughs] Now, they could have some backfires, but if you built it well, and if you had – because to a certain degree… I wonder if you can get better because CBT is such a trained thing; I wonder if you can actually train your own thought process by judging other people’s thoughts, just like you could your own thoughts; I have to get a psychologist to answer that one…
Well, something to tee that up real quick - behind the scenes we do have a plan for a show in the very near future called Brain Science. You may have heard the previews at the end of our shows recently.
And you may have even e-mailed us about it with some exclamation points after saying “Brain Science” in the subject line. Super-cool, but something that Mireille Reece, the doctor of clinical psychology I’m working with - something she says often is “You have to put your lid on”, which means your frontal lobe. That’s what makes us humans. Mammals have the mammalian brain, the brain stem, then there’s a different portion of the brain, but this front part, behind the forehead area, is where you carry most of your cognitive load. That’s where really a lot of your human behaviors, your human thoughts come into play… And what often happens probably in these scenarios where somebody is in these deep fears is that they’re not thinking with their full brain, their frontal lobe, so to speak; they’re thinking just brain stem only, very survival mechanisms like “Don’t die” scenarios. They can’t put their full lid on; that’s something she says.
So the purpose though of this application is to change somebody’s thought, right? You say here at the end “Finally, we get to the entire point of cognitive behavioral therapy, which is changing your thoughts.” So not only is it to supplant potentially a relationship in a scenario - Jerod, your idea of actually putting some anonymous humans behind this is pretty interesting, but the point is to sort of identify the lie, and then help you seek some sort of truth to change the thought portion of it… How are you determining – when you put this text in… You know, this example, I believe, is like “Because I took too long, I’ll bet I failed the interview.” So how are you taking this kind of input and turning it into not only these cognitive distortion options - catastrophizing or fortune telling, for example - in a way that enables those using this to change their thoughts?
[00:36:10.17] One of the things that CBT does, that the app doesn’t do very well, but hopefully will in the future, soon, is that it says that there’s like core beliefs that are causing your problem. So you might have something like “I failed that interview, and that’s really bad”, and you might think that the thing that you need to change is the “I failed the interview” problem, but that’s not necessarily true… Because the reason you have failed the interview, or the reason you think that you failed the interview and that you’re worried that that’s so bad is because you’ve connected yourself to this career success. So one way you can tell and figure out what is your deep problem that’s causing this is you can ask a “What if true…?”
Let’s say you think that you failed that interview, and then you say “What if it’s true? What if I failed that interview?” And then you might think like “Well, if I failed that interview, then i won’t get any other interviews. Then if I won’t get any other interviews, then I won’t ever get a job in this industry…” If that’s the thing, whatever you end up with, that’s the thought that you need to change, because that’s the thing that’s driving everything else. So if you can get to that thought, then you can challenge it and say “Okay, this isn’t actually true, and it doesn’t need to cause me the stress that I’m giving it.” Then at the end you can write a different thought to this situation, and you can acknowledge what’s true, because you shouldn’t lie to yourself, because that’s not helping yourself anyway.
So you can acknowledge that maybe you didn’t do as well as you wanted to in that interview, and that maybe that means that – you can acknowledge that it’s true, that some parts of it are true, but at the end of it, you need to find your way towards realizing that it’s not as important as you think it is to be a successful programmer, or something. You don’t need to be that to be happy, because lots of people aren’t programmers, and lots of people aren’t this thing. But it also doesn’t mean that you have to give up being a programmer, because lots of people are just fine, they’re average-level programmers, and they’re quite happy and perfectly fine.
One of our hopes coming out of this show is that people listening to this that maybe identify with the struggles that we’ve mentioned, or even relate any little bit to the things we’ve been talking about, if CBT is truly self-administering, at least based on Quirk, the next logical step might be to try the app. What’s the first step, how do you actually try the app? Do you go into the app store, download it? What’s the first step?
It’s available on Android and iOS, but what I would recommend is if you’re interested in this, go to Quirk.fyi and read the description that’s there first, because it’ll give you an overview of how to actually do this… And I think that little bit of education is particularly useful for it to be helpful for you. So I would definitely recommend that. And then there’s a download thing at the bottom.
That makes it easy. Download it in the App Store, download it on Google Play… Fairly easy to get. I mean, there’s some education behind it, like what is fortune telling and things like that, but that’s a good first step. Plus, also if you’re a software developer - and if you’re listening to this, you’re probably a software developer, and if you’re not, hey, welcome; we talk about software here, and open source, if you didn’t know about that… But it is also open source, which means that if you desire to, you can also give some feedback. But I understand too that there’s a second component to that, that you actually wanna talk to people engaging in mental health, so professionals out there that are wanting to take part; the cool thing about open source is you can actually influence Quirk and share some ideas with Evan. What do you think, Evan?
Yeah, so there’s actually two things. If you’re a mental health professional, if you’re a therapist or you’re a psychiatrist and you want to help the app, send me an e-mail. My e-mail is email@example.com. And if you’re a mental health professional or a therapist or a psychiatrist and you’re interested in helping this project, please send me an e-mail… Because I do not have a mental health background, I don’t have a degree, so I’m definitely looking for professional help, if anybody is interested.
Secondly, if you’re a researcher and you’re looking to study cognitive behavioral therapy or you’re looking to study the app, one of the things Quirk is trying to do is be both private and public. By private I mean that the thought records, the things you store in the app, the thoughts - they’re never shared anywhere. They store on the device, they don’t go anywhere. All your private information is not collected. But all the usage statistics, which would be collected by the App Store or your OS, is shared publicly. Anonymous usage statistics, like “How many people are using this app? How often are people using this app?”, stuff like that - that’s shared in a csv file which you can get… And if you are interested in doing research on Quirk, this is just open for you; it’s actually open for anybody, but specifically if you’re trying to find the effectiveness of this app, especially when compared to worksheets, or other forms of collecting thought records - this is for you.
Those kinds of people that are looking for this - do they know they’re looking for this? I’m not sure how often mental health professionals cross over to the software world, but that seems pretty interesting to me, especially when it comes to data. What is your awareness of data pools, or data lakes, or anything data-related when it comes to this kind of thing, and those who are professionals in the mental health field?
What do you mean by that?
Meaning like where do they go to get their data? Do they simply rely upon research? This isn’t exactly research, but it is data, and it’s true.
Yeah. I mean, people set up studies, so that’s one option… A lot of this stuff is done on paper, so in the past it’s been particularly difficult to do real studies on it… And there are a couple technological solutions for cognitive behavioral therapy (and therapy in general), but as far as I know, a lot of them are very proprietary and don’t really share their information, and they might commission their own studies of it… But there’s no really solid third-party impartial studies that I’ve seen.
Typically, when I was doing research and looking at what outside people are doing research on mental health apps, they’re typically going to the app store and collecting the amount of rating on the apps, and they frequently don’t even know the amount of downloads that the app is getting… So the actual data out there isn’t super-great, which is part of the reason why Quirk is public with its information. So if you’re trying to figure out whether or not this stuff works, here you go. This is the tool.
[00:43:41.21] Is there ever a point that data – given this concern of anonymity, or very private concerns for your users and whatnot, is there ever a point that data is not anonymous? Are you getting the data and then anonymizing it, or is it always anonymous to you?
It’s always anonymous. I’m not recording – well, for one thing, Quirk doesn’t have user accounts, and we have no way to connect it to you; so it’s stored like an anonymous ID, which is basically just a UUID that’s associated with you, and that’s it. That’s all we have.
We do collect the phone that you’re using and the language you’re using on… But the information that will be shared won’t have the anonymous ID, I think; I don’t remember whether or not that’s a thing yet. Basically, my goal is to not share any personally-identifiable information, and not to collect it. And the thoughts themselves, especially like the most private information, is just never even collected.
So it’s just parsed into real-time, given some of these responses to parse through and whatnot… It’s never stored.
Yeah. And the code is also open source, so if I’m doing this wrong, or somebody disagrees, or would like to audit it, feel free. It’s all collected very openly, so if there’s something that I’m doing wrong, please let me know.
One thing to mention too is that you mentioned languages being something you collect, and one interesting fact here is when it launched on Hacker News, it was translated in two days into seven different languages. Can you share the back-story on that?
Yeah. I remember when it first launched there were a number of people who made a GitHub issue that said “I would like this app in whatever language”, and I was very skeptical; I couldn’t imagine that anybody would actually be willing to spend the time to go and translate this. And then I had a friend who had done some localization work before, and so he went through and set up the process of localization, so he basically moved all the string files over into a JSON blob… And then people just translated it, and it was incredible…
…because people didn’t just translate it, they went and looked up the research of what cognitive distortions are called in their own language… So they didn’t do a literal translation, they did real research, and that’s amazing. That’s absolutely amazing! And it’s ten languages now… Seven in the first two days, but now it’s ten. There was one this morning.
I’m not gonna get all of them, but let’s see… There is Chinese localization, there is a Russian (I wanna say), there is a Polish, there is a Spanish, there is Portuguese, there’s a Norwegian this morning… And I’m definitely forgetting – I know there’s ten, but I don’t remember all of them off the top of my head.
Where is the list of the languages? That way, if someone is listening and saying “Hey, is my language listed? If not, I wanna help.”
You can go to GitHub and under the contributors list I have a list of all the translators. I think the Norwegian and the Portuguese isn’t updated yet, but there is no [unintelligible 00:46:38.22]
Oh, gotcha. Right in the readme. Great place for it.
Yup. So if you speak another language other than English and you are interested in translating it, there’s a whole readme file that’s a translations.md; you can click on that and there’s a whole explanation of how to translate it. Even if you’re not super-familiar with Git, if you are comfortable using the GitHub user interface, you can translate it just from the GitHub user interface.
Yeah. Or even open up an issue and say “Hey, I wanna help translate, but I could use some guidance, or some help.”
Yeah, I’m happy to help. I’m absolutely happy to help. And if you do translate it, there’s stickers in it. I will mail you a sticker…
Because it’s absolutely amazing.
That’s enough right there. I mean, most people would fight somebody for a sticker.
What about you, Jerod? Have you fought anybody for a sticker before?
Um, not today. [laughter]
What about resources, Evan? We started the call by talking about your personal perspective, so this is a “scratch your own itch” kind of scenario here, so it would make sense… But not only did you go through the process of identifying that you’ve got some mental health challenges that you needed to go and seek either self-help or professional help, but then you got educated enough to actually make something that was useful for other people, yourself included… What were some of the resources you used to learn about CBT? Was it just simply therapy, or did you read books? What did you do?
[00:48:05.15] I did read the book “Feeling Good: The New Mood Therapy” by David Burns, which is the pinnacle book on it; definitely the right thing to read. But to be honest, the amount of resources available for cognitive behavioral therapy are kind of slim, and that’s one of the things I would like to try and do - is to create open source resources for cognitive behavioral therapy… Which is why Quirk is quirk.fyi.
I would recommend that if you’re in a particularly bad situation, you should go see a therapist, because they will be the best resource for you. They will be somebody you can ask about questions for, they’re the right person.
I love the .fyi domain, by the way. Jerod, I wasn’t aware, I didn’t look up the site; it’s terrible. In mid-show I’m looking at the site, quirk.fyi, when you mentioned the URL… And that’s the best, in my opinion. I love the fact that, like you said before, it’s serious, but you wanna approach it in a way that sort of like calms things down. It doesn’t make it so serious that it’s like a medical app that’s blue, or a certain color that identifies with medical, for example.
I can identify back with me, and this isn’t exactly totally appropriate, so I’ll use the acronym - I had an acronym that whenever I was in my scenarios, that I would say to myself “CTFO”. And if you’re smart enough, you may be able to decrypt that. “Chill the … out”, whatever. That’s what I would have to tell myself, because I would have to identify with this. It’s crazy. And in that case it was whimsical, it was quirky, so to speak… So you need to take the serious thing, but not make it so serious, so .fyi is amazing. And I didn’t know .fyi was available to even use. I’ve got so many ideas for some stuff now. I have to do some fun stuff with .fyi.
It’s a good domain. Lots of stuff available for it, so… Yeah. A long time ago I was interested in game design, and there’s this concept in game design called Juice, which is like anytime something like wobbles, or spins, or buzzes… And it’s the things that make games feel fun intrinsically… And that was the reason for a lot of decisions in Quirk. If you open up the app and you go to the settings, there’s a little asterisk at the top, and then each setting has a little asterisk in the header/sub-header, and it’s part of like trying to be a little bit interesting, and trying to be a little bit juicy in the game design terminology… Which is just like this little bit of fun that you can have with the user interface. So on the website, if you click on quirk.fyi and then you go to About, or you go to App, it will change it to be Fyi About the App, or Fyi About Quirk.
It’s like little changes, but unique enough it could be animation, it could be tweening, it could be just simply title changes… Anything to sort of like change, to make it slightly more satisfactory, or more fun, or that kind of stuff.
It’s a little extra bits.
Is this new to you, Jerod, this concept of Juice game design?
I’ve never heard it called Juice, so yes.
It’s sometimes also called Game Feel.
So they consider these aspects of game design.
I’m over here thinking, is there a .btw TLD? Because that’s what I want.
Honestly, yes. That’s good.
Is there really?
That’s right up there. I don’t know, but if there’s a .fyi, there’s gotta be a .btw. That’s one of the most commonly used acronyms.
This is why we [unintelligible 00:51:22.19] and get a TLD, or however much they cost to make.
That’s right. We just become a registrar. We can have our own .btw.
So we’ve talked about the open-sourceness, we’ve talked about the translations, which is awesome; I love seeing that, getting this into more people’s hands in different languages… And it seems like the kind of app where the specific words are so necessary, but it’s not like there’s a lot of text, from what I’ve seen… So it seems like it’s reasonable to do a translation relatively quickly if you are well familiar with the language that you’re translating into.
You talked about the metrics, and how those are gonna be open, or are open to those… What else is looking down the road for Quirk, besides my amazing, awesome community features, which Adam loves…? Aside from that, what else are you looking to do with this? Is it kind of done? Has it done its job? We know it’s helping quite a bit, but what else do you see down the road for Quirk?
[00:52:18.12] I wanna help people find therapists… Because a lot of people who are using Quirk aren’t seeing a therapist, and that’s like a good opportunity to get a whole bunch of folks who probably need a little bit of extra help, and they’re in the front door… Because there’s a lot of things that keep people from seeing a therapist. I went many, many years without ever seeing a therapist. Part of that is stigma, part of it is because it’s not a medicine you take… You think that it might not work, or that it’s not as evidence-based or effective…
And so at the moment, a lot of the people that use Quirk are kind of in the front door, in that they’ve stuck their head in. They’re like “Hey, what is this thing?” And a lot of those folks could probably benefit from seeing a therapist, but Quirk has no way to direct them there at the moment. And because Quirk is made by me, who’s just some programmer dude, there’s a responsibility to make sure that they can see somebody professionally… So one next step for Quirk will be to help people find therapists, or at least to help them find cognitive behavioral therapists, people who are very specific about this.
So if you are a cognitive behavioral therapist and you would like to be listed on Quirk’s website, let me know, because I will probably have a listing somewhere, and probably that is in process.
Or if you have ideas about good ways of implementing that in the application, on the website etc. It seems like there’s lots of opportunities for involvement and help, and definitely going towards something that’s helping people, as it says at the bottom of the page, really feel better. I love that. You really can feel better. It seems like it’s doing that for you, and it’s doing that for others, and it sounds like the more languages, the more features etc. it can reach a lot of people.
Earlier on you emphasized how free it is - both free as in open source, and free as in beer, as in like free, no cost. That seems like something that’s very important to you. Do you wanna expand on why that is? This is obviously a place where it’s providing a real value, you could probably make some cash with it.
Originally, it actually was paid. When I first released it, I charged $2 for it. I made a couple thousand dollars off it, which is cool, from people coming in…
But at a certain point there wasn’t as much – I don’t think it is useful to trap something that is so incredibly helpful for people behind a $2 paywall. And a $2 paywall is nothing; it’s not that much. People spend more than that on their coffee. But if that $2 paywall is the thing that keeps you from finding something that actually helps you… Because for me, this was the thing that made me go from having two panic attacks a week to not having one for three months, and then not having another one for three months before that… And if it’s gonna be a $2 paywall that’s gonna keep you from getting there, then why is there a paywall? Let’s just get rid of that. It’s so much more beneficial. The value created for everybody is so much better than the $1,000 that – $1,000 spread over several months, which isn’t that important. It’s not as important as helping people that actually need it, helping people like I were.
Yeah. I think the application is the tip of the iceberg. There’s so much beneath the surface… The true value is the open door that the application brings, and I agree with you on the – I mean, to some people $2 isn’t much, but when you multiply by (let’s say) half a million or a million, it starts to get to a larger number, if that could ever be the potential of it.
And it’s not even the affordance, it’s the fact that it’s a roadblock between actually trying something and not. And we are used to - especially on App Stores, on mobile phones, the commoditization of apps has brought the price down to zero.
And so any price, people will turn their nose up. Even if this could help actually make them feel better in their lives.
It’s almost like a trust-builder even, you know?
Yeah, for sure.
[00:56:07.02] Because if you’re paying for it, it’s like “Why two bucks for this…? Is that their motive? What is their motive?” So by pulling this $2 off the table, you’re sort of opening yourself up to a question of what’s your true motive, and your true motive is to help.
In a lot of cases, people in these scenarios need hope. Hope of change is so significant to actually enabling change. If you have no hope, you’re hopeless, and you tend to be more negative… And I think that you’re right, the two bucks is such a barrier to pull off of to enable hope.
Yeah. And I wouldn’t say that I’m against people taking money to help people. If you go see a therapist, a therapist is going to charge you for their services. And I’m not saying that a therapist should do that for free. Financial motivations aren’t inherently bad, because people still need to eat. But if the relative amount of money that you can make from having a paid app on the App Store, versus the overall amount of value that you can do - at least in the case of Quirk the app, I just didn’t think that was as useful. There’s more value.
That’s why I really like the idea of you adding a cadre of mental health professionals behind this at some point, or being open to that. If we’re forecasting some financial opportunities here, some ways, then that’s a way you could get there, because the open door and invitation, I agree, is better off and has more value being free, in all senses of the word, not just simply at cost, but as we described what free means… But I think there’s an opportunity in other ways that still you can provide that value, but in ways that lead people to change and lead people to solving some of these problems, and the base application itself, of what it is, remains the way it is, which is free.
Yeah, I agree with that. If I was Talkspace - Talkspace is an online therapy company - I would release something like Quirk and give it to everybody. Because 1) it helps people tremendously, and 2) it would both be useful for the people who are currently seeing therapists, because it’s useful if you’re seeing a therapist, and it’s also a front door. It’s like “Hello. This is a thing that you can do, and it actually is effective.”
You know, given what you’ve shared here, what’s some variation of the future you’d like to see? Have you thought about that? Where are you at with where things are going?
To be honest, I go where people tell me to. Everything that Quirk has built so far is just people using it and then asking for things. So I don’t plan too far ahead, I just go with what people have asked for. Recently, people have asked for translations, so I made sure that it is translated in a bunch of different languages. Another thing people have asked for is a lock screen, because these are really private information, and sometimes other people are using your phone, and you don’t want to necessarily have somebody open up the app because it’s got a cute icon, and then all of a sudden see your deepest, darkest secrets. So that’s something that’s coming down the line. And the other thing is stuff that you guys were mentioning - there’s a lot of stuff you have to learn, so improving the education experience is better.
The thing that stresses me out the most is that a lot of people don’t look at the help within the app, or don’t realize it’s there. From people I’ve talked to, they just didn’t realize there was a Help screen in the app, which probably is my fault, and something that needs to be a little bit better and noticeable… Because I think it’s harder to get the value out of it without having the education behind it. So education is probably another big piece.
Well, Evan, thank you so much for sharing your personal perspective…
I really appreciate you being open about it, and I guess maybe even thank me too, yeah…
Yeah, you did too. That was great.
[01:00:02.21] Because I never share that kind of stuff. Jerod and I, on this show, we’re less the talkers and more the facilitators, so it’s not often I get to share personal attributes about me in that realm.
I think you should, it’s good.
Anyways, I’m done patting myself on the back. Thank you, Evan, for sharing your thoughts. I appreciate that. We need people to be vulnerable in those ways, in environments where they can be vulnerable and not be judged, or berated, or told they’re wrong, or whatever.
Yeah, and thank you.
Also, thank you for the freeness of this, in all sense of the word; the openness of this. Because I think the things you just shared here are super-crucial to some change in people’s lives, and providing that level of hope. I love what you’ve done here and I’m glad you reached out to us to share this with the community.
Anything in closing you wanna share with the community, any core takeaways, any calls to action, anything left on the table we haven’t put on?
Basically, if you are a mental health professional and you wanna help, reach out to me. And if you are a developer and you wanna help, there’s definitely some features and bugs that need fixed. And if you are a translator or somebody who speaks another language and you’d like to translate it into a language that it doesn’t exist in, also reach out… Because this project needs all the help it can get. Thank you so much.
We’ll put your e-mail in the show notes, but remind us again what your e-mail address is.
And if for some reason you’re listening to that and you’re driving, or anything where you would be dangerously trying to type or remember that - check the show notes; it’s there, don’t worry. We have pretty good show notes. And by the way, speaking of open source, if you wanna help us improve our show notes and/or the transcripts from these podcasts, those are both open source. You go to the episode page of any of our podcasts, there is a neat little edit link there that takes you to GitHub. This does assume you’ve got some GitHub knowledge, but if for some reason you don’t, and you wanna reach out, we’re pretty easy to get a hold of as well, firstname.lastname@example.org and we are happy to invite anyone in this community and happy to help anyone that comes along.
Thank for listening, Evan thank you for sharing, and we really appreciate your time. Thank you.
Thanks so much.
Our transcripts are open source on GitHub. Improvements are welcome. 💚