In this video, we talk with Easy EMDR Founder and CEO Zach Jordan about the role of integrated video in user experience for digital health care. Zach tells of his journey building a telehealth product, why they chose Daily, and the importance of a clean, simplified user experience in telehealth therapy.
Pete Hawkes, Head of Design at Daily
My name is Pete Hawkes. I'm Head of Design at Daily. I'm here with Zach Jordan, Founder and CEO of Easy EMDR and Matt Donaire-Stoner, Director of Customer Support and Social Media. Thank you all for joining me. I'd love to spend some time going a little bit deeper into the backstory of the origins of EMDR. Zach, what was the impetus for this idea to begin with?
Zach Jordan, Founder and CEO of Easy EMDR
So, back in 2016, I was doing some EMDR sessions myself. EMDR is a type of trauma therapy. It stands for eye movement desensitization and reprocessing. And it requires specific tools to issue it properly. You can issue it in a variety of ways, but therapists often rely on technology to issue it.
And so at that time, my therapist was using this very antiquated mobile app. It was very bare bones and just kind of brute force trying to do the minimal that it possibly could to get the therapy issued. It felt like we were always having to work around the technology instead of the technology working alongside us. It was kind of like a one-size-fits-all type thing, which for EMDR is not really what you want. You want it to be set up so that the client can be as comfortable with it as possible.
So I created my own free version of the tool which is still available today that just provided a virtual implementation of this technology with some improvements that I thought could be added. And this tool went semi-viral and began spreading through word of mouth primarily as well as online amongst EMDR therapists and their clients.
And I started getting contacted by these people asking me to add this and that to the tool saying they really liked it, but they thought it could be a lot better. I decided to build a much more expanded version of this tool which eventually launched in 2019.
Pete
Thank you for that. Those first sessions, were they in-person sessions as well?
Zach
Yeah. Yeah, they were in-person. We were using virtual tools strangely enough, despite it being an in person session.
Pete
That's fascinating.
Zach
Yeah. But that's often how it's done.
Pete
And I'm curious, what types of feature requests did you receive from therapists as you were developing that more robust version of the tool?
Zach
So, EMDR uses a visual or an auditory stimulus. It can also use a tactile stimulus. But at the time, we were mostly focused on the visual element. So people wanted us to add first they wanted to be able to customize the visual stimulus. So changing the speed, changing the shape, the colors, the entire look of it.
Additionally, people wanted auditory stimulus tools as well. So now we have a whole library of audio effects that can be used during a therapy session. And people wanted the ability to issue treatment remotely more effectively.
Our original tool was built with in-person sessions in mind. But we quickly realized particularly during COVID that remote sessions are just as important (if not more), and are becoming increasingly important as time goes on.
Pete
And why would someone want to modify or customize shapes and animations?
Zach
So each client will have a certain way that they like it to be set up where they feel most comfortable tracking the stimulus, whether that be visually or audio or using audio.
And it has to be at the proper speed. It has to be just such that the client feels very comfortable following that and focusing on that while they're discussing a traumatic event with their therapist. You don't want the stimulus to be distracting in any way and you don't want it to be frustrating to follow. The focus should be on processing this event that they're working through. So now the therapist and client can work together to customize the stimulus throughout the course of a session.
Pete
In our post pandemic era, the use of remote tools for telehealth is important. But why is there a particular advantage in this case to integrating video with the tool?
Zach
It's actually more important in an EMDR session in particular than it would be in a general therapy session. And the reason why is because the therapist has to be following the client's eye of movements throughout the course of the session. So of course, you need video to do this and you need a robust video connection that's going to allow you to do this smoothly. So video is very important. It's important to watch the client's eye movements and watch for their body language and posture. How quickly are they breathing? All these sorts of things [ensure] that the therapist has a really good idea of how the client is responding to in real time.
Pete
And why Daily? How did you end up using our API in particular?
Zach
Yeah. So it's a couple of things. Daily offers a robust and very simple solution for achieving HIPAA compliance in a video environment. So that's one thing. The second thing is configuration. Many of our clients were asking for a robust integrated video. A lot of people were using other platforms like Skype or Zoom, but it would be really annoying because they would have to have our program pulled up and then they would also have these video programs pulled up and they would need to switch between them and toggle between them. It was a whole nightmare to do on the fly when you're still learning about remote treatment.
Daily allowed us to have an integrated video that's embedded within our application. And the therapist can just use our application and talk to their client and then have it all be a seamless unified experience.
Pete
Continuity is important, like session-to-session, or from patient-to-patient.
Zach
Yeah, that, that's also a variable. So just having a consistent experience, they're not having to do something different for one client versus another.
Pete
Is computer savviness something that gets in the way?
Zach
Yeah, I would say so. The complexity goes up, the more programs that a person has to manage at one time. So that's why an integrated solution was so desirable for us. Um, because it's just something, uh, on the user end it doesn't really add much more complexity. They just go, they pick their client, they send them an invitation link, just like you would any other platform, the client opens it and joins the session and then the video call has already begun. Nothing additional has to be done; it's a lot simpler for both the client and the therapist. They don't even need to worry about the video platform
Pete
I can imagine in a telehealth scenario (where the whole point of the session is to address things like anxiety) that additional tech-induced anxieties don't help the issue at all.
Zach
Yeah. Yeah, definitely. And we also work with lots of therapists who have spent their whole careers doing therapy in-person. And so they've gotten very accustomed to that workflow. When COVID hit, a lot of people had to change their workflow on a dime. And so it was really important to ensure that the learning curve is as easy to navigate as possible.
And as we know, remote work is here to stay. So a lot of therapists continue to do sessions online. A lot of them do a combination of online and in-person. So having a solution that is simple to use in all these cases is very important.
Pete
Fantastic, I'd love to see the product. I'd love it if you could take us through the interface itself or the various ways that therapists are able to customize.
Zach
I think what we'll do is we'll just run through a practice session with Matt and I. Let's jump right into that. Ok, so, I copy the invitation link…
Matt
…so I just click on the link, and then it automatically puts the code for the session meeting, and I just have to hit submit.
Zach
All right. And then I just start the session and it will begin loading.
So I was ready to join now. As you can see, I can see Matt and Matt can see me. We're in the preliminary stage of starting a session. So, I'm in the role of the therapist right now, and Matt's in the role of the client.
So because I'm a therapist, in this case, I would begin by taking some notes. Easy EMDR provides integrated note taking, so the therapist can do that as well. I'd begin by writing down the triggering event that is going to be processed and I'm ready to start. Now we are in the configuration stage of an EMDR session.
So this whole time I can see what Matt's doing. I can talk with him, he can see me. We're able to see and hear each other just fine. So the first thing that a therapist would do is they would begin by customizing the bilateral stimulus; you can see the visual stimulus right here. And you can see the changes that are made to this in real-time, which is really important just for getting something that will work for both the client and the therapist.
So I can change the speed, I can change the size, the shape. I could pick out a nice shape if we want to pick a butterfly. I can modify all the colors. And we can also do things like add a bilateral audio. So we have a vast library of audio effects that can be used in session. Backgrounds, all sorts of things to customize. Kind of the look and feel of how the session is gonna work for the client.
We can also check the path of the element so we can modify this and change the animation type as well. And this whole time I can talk with Matt about what his preferences are and we can work together to find something that's going to really suit the needs of both the therapist and the client
Pete
Got it. The patient can interject basically and often helps choose these elements.
Zach
Yeah. Yeah. Not only can the patient interject. They have an interface on their side that looks quite similar to this. So they're also able to select things that they want to have. So they could come jump in and change the speed themselves if they want to. But then as soon as we're ready here, we just hit start and the bilateral stimulus starts running.
So now an important thing to note here is that I'm able to track my client's eye movements in real-time with this. So the stimulus is running in full screen on the client's view. But I can see both my client and the controls from the therapist's view. And this is really important because it allows the therapist to watch eye movements. I can watch the client's physical presentation.
I'm able to watch the client's facial expressions, their breathing rate, see if they're fidgeting or not, see if any ticks are expressing themselves. Things like this. This is really important for building a clear connection with the client as well as providing a safe environment for the client to experience the session in.
And it's really great for maintaining eye contact and all these things that you'd be doing in an in-person environment. So we try to replicate this in the remote session as closely as we possibly can. I can pause the stimulus at any time and talk with the client to see how things are going. And I'm also able to modify the controls on the fly here. So if things are too fast, we can slow it down.
It allows for this great real-time feedback as we set things up and make sure that it's going to work for everybody. And then I can start it right up again. I can also drag the bilateral stimulus around so I can get it out of the way and have a full view of my client while the stimulus is being issued. But let's end it for now, just so I can show off some other things.
Pete
I'm curious, I'm curious how long a typical session lasts?
Zach
Yeah. Yeah, usually an hour to 90 minutes; somewhere in there. There's some research that indicates the longer sessions can be a little bit more effective. But I think most people meet for an hour. Usually that's usually how long my sessions were.
But now usually in the course of a session, we would run through this process of running the stimulus and pausing it and talking several times.
So, while we're talking, I'm also able to use this full screen option and go into a full screen mode where we can see each other just like a normal Zoom call or something like that. And this allows us to just do some straight up talk therapy and just chat with each other and see how things are going. If you wanted to, you could just do talk therapy on our platform.
Using this feature, you could ignore all the other stuff and just talk with your client. There's also some nice quality of life features here, like background effects. You can see I have one toggled right now. I could turn that off and you can see my real background. I can make it look like I'm in a variety of places just in case there's something going on in the background or things like this.
There's also the ability to toggle the video quality to improve the connection, which are important things in the context of a video session where having a really solid connection is going to be important. We also have the ability to open up a chat log so I could speak with my client in a chat if I'd like to. This is a secure kind of chat messaging. And then at the end of this, I could download the entire chat and have that record saved for after the session.
So you can kind of alternate between these tools throughout the course of a typical session. And then whenever we're ready, we can just jump right back into the B L S. And these are just kind of cycled through over the course of a typical session.
Pete
That's great. You mentioned specifically that a part of this therapy, one of the core requirements I guess of a therapist, is being able to read even very subtle body language from the patient. So given that, are therapists able to key in on those very subtle body cues that they're looking for?
Zach
Yeah. Yeah, definitely. So when we created the video experience, we were adding that that was a big change to our products. So we wanted to think about it a lot. And ultimately, the kind of strategy that we've pursued is trying to emulate the advantages of an in-person session as closely as possible in a video environment. Like we said earlier, a lot of our therapists who use our platform were already used to in-person treatment, so we wanted to ensure that there is a very simple transition to the remote world of teletherapy.
Pete
That's great. Are there other aspects to the product that you would like to show today?
Zach
Oh, I suppose we definitely like this ability to add data. We can take notes on how my client is responding to treatment. So I could say something like “going well”. And then it also allows you to evaluate these other metrics that therapists are tracking over the course of a session. So this includes things like subjective units of disturbance and validity of cognition.
How true are these stories that I'm telling about myself? How true? Actually do I feel them? Memory recall. How well can a client recall this traumatic event during a session and then finally, their mood, how is the client feeling? So this can be saved over the course of a session. So I'll just save a couple of data points here.
Just to give you a little idea of what this would look like. I could also be saving notes during this entire time. And then let's see what happens. This allows us to then generate a report that will graph the the values that I saved over time, as well as save all of my notes. And this report is automatically saved at the end of each session.
Which means that after the session is over, the therapist assesses that they can refer back to and they can see, well, how did this go? How did my client feel during the course of the session? How effective were various parts of it? What can I do better next time, all these sorts of things? And it's really good for just tracking how a client is responding to treatment over time.
Typically, you wouldn't just be doing one EMDR session, you'd have a client coming in multiple times. So you'd want to track how they are progressing from session to session. And this feature is really good for doing that.
Pete
What's next for your business? Are you focusing on anything in particular? Are you tracking towards any new evolutions or features?.
Zach
Yeah, we have a feature that we're really excited about. We've been working on it for a while. So Easy EMDR has a mobile app. It's available for both iOS and Android devices. And we're currently in the process of adding remote sessions to the mobile app soon. Everything that we've just shown you will be in the mobile app and therapists will be able to issue treatment from a desktop computer or a phone to somebody else who's also on a desktop computer or a phone.
They'll be able to join from whatever device they have and get an optimal experience video call included. All the customization options included from their mobile device. And that's really valuable because not everybody has access to a desktop computer, but phones are very ubiquitous. So if we can provide a great experience on a phone, that's going to be really valuable for people who couldn't access this therapy before. So we're really excited about that.
Pete
I'm curious since kind of comfort level and distractions are so essential to the process. Have therapists mentioned that the device itself—say a patient holding a phone versus sitting in front of a laptop or a computer (which might be a little bit more imposing)—that just holding a device [makes them more comfortable and is] an added benefit to this therapy in particular?
Zach
Yeah. Yeah, that's an added benefit. And I would just say the addition of more choice is always an added benefit. So you're going to have people who prefer different things. One client might feel really comfortable using their phone because that's the device that they're used to using. Another client might like a bigger screen on their desktop computer.
Another client might want to use a tablet that they have. We want to make sure that whatever the client feels most comfortable with, they're able to use that and receive quality therapy. That's kind of the name of the game when it comes to providing more options so we're really excited to introduce the new version of the mobile app very soon.
Pete
Now that's exciting. What advice would you give other startups, whether they're in telehealth or otherwise, who are looking to integrate video into their products?
Zach
I would say picking a platform with a small amount of technical friction is going to be important. You want to be focused on the product side of things and taking care of what your users are asking for. And you can't do that if you're just constantly dealing with technical problems that are related to video. So, we really thought Daily has been positive for this.
It was really easy to get set up with [Daily]. There's been very little fuss in terms of, you know, maintaining it. And we constantly get new features through the Prebuilt UI without us having to add them ourselves. So it's kind of a technology that has gotten better with very little work from us over time, which is a good thing if you're trying to focus on your product. Especially if you're in the teletherapy space where continuity of treatment is really important, you want to be focused on that and not the video call stuff.
Pete
Great advice and thanks for sharing. Well, thank you for taking me on this nice walkthrough of your product and your own journey. It's really fascinating to hear the various perspectives, both of patients and the therapists that use and benefit from your product. It's been a pleasure. And I'm excited to see what's next for Easy EMDR.
Zach
Sounds great. Yeah, we're excited to see what Daily is working on, so the feeling’s mutual.
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