
Quirk – Open-Source Cognitive Behavioral Therapy - flaque
https://github.com/flaque/quirk
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cassowary37
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.

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

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superasn
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

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

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superasn
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
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

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

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DavideNL
> "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.)

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flaque
This is a good point, will do.

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Gerrish
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
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?

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Angostura
An example on iOS being?

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TomMarius
I didn't consider that, sorry.

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cjw3
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.

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fxfan
Please share!

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modi15
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.

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flaque
> 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
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.

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pandatigox
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?

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navs
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.

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RootKitBeerCat
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

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jdorfman
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
> 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.

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

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flaque
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 :(

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zuzuleinen
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?

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

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

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

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flaque
Lol nope! Good catch thanks!

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

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flaque
Does this help?
[https://play.google.com/store/apps/details?id=tech.econn.qui...](https://play.google.com/store/apps/details?id=tech.econn.quirk)

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trendoid
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
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

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

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ntlk
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.

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

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

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onesmallcoin
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

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tastroder
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.

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kodz4
How frequently in a day is a reminder healthy?

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

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

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

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codemati
Great idea.

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

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

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

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wolco
Great idea.

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

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dfrage
_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.

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therealdrag0
> 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?

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flaque
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.

