A New Device Promises to Help You Stop Picking Your Skin. Will It Work?
By: Angela Lashbrook
Tags: Gadgets, Consumer Tech, Health, Digital Life, Technology

“Awareness is the first step,” says Aneela Idnani, the co-founder of HabitAware and designer of Keen2. “Then you can actually use all the other strategies that a treatment professional is trying to impart on you because you can’t make that change without knowing that something is happening.” While the original Keen worked primarily for raising awareness, Idnani says the Keen2 will go further, connecting users to Habit Reversal Training strategies that they might otherwise learn from a therapist.

In order for the device to be able to identify the behavior the user wishes to remedy, the user needs to train it by briefly participating in their behavior while wearing the Keen for the first time. The user picks their skin, bites their nails, or otherwise engages in their BFRB for 15 to 20 seconds while the device is in training mode. If they have more than one BFRB, they need to train the device for each one. So if I pulled out my eyebrows and the hair in a particular spot on my head, I would need to train the Keen for both situations.

Body position matters, too, because it impacts the particular angle the hand will be in while it’s pulling or picking. If I knew I tended to pull out my eyebrows while watching TV, I’d want to ensure I train the device while in the position I sit in while sitting at the TV. If I do it while sitting at the TV, sitting at my computer, or lying in bed, I need to train it for each and every one of these activities to avoid the device vibrating while doing something totally unrelated — for example, while petting my dog or getting something out of the fridge.

Training a machine learning algorithm accurately is hard enough for researchers who have been studying AI for decades. For the layperson, it can be incredibly difficult.

Arno Klein, PhD, now the director of Innovative Technologies at the Child Mind Institute, where he is working on a wearables program to research mental illness, previously worked on an app meant for people with Parkinson’s disease. Parkinson’s, which is a nervous system disorder, sometimes causes people to have tremors in the body.

“I think it’s one of those things where we think technology could be helpful — the story makes sense. But how does it work in the real world? I think we don’t fully quite yet know.”

Klein and his team wanted to see if people with Parkinson’s experience changes in the voice. His team gave people very explicit instructions, such as saying “ahhh” for up to 10 seconds. “And just that single sound — I can’t tell you after listening to hundreds of these recordings are different people, how many people couldn’t even get that instruction right,” he says. People would make the wrong sound — “eeee” instead of “ahhh,” for example — or the data would be unclear because of other sounds, such as a barking dog, in the background of the recording. Asking people to train their own devices is “most [of the] time bound for failure unless they’re very motivated. So you’d like to think that people with conditions that may be self-injurious are motivated.”

Even if the device is well trained, though, it can still struggle to accurately identify when someone is engaging in their behavior versus doing something else. This depends on particular features within the device, such as accelerometers, which sense movements and vibrations, or gyroscopes, which sense velocity and orientation. Devices that can’t detect super specific movements — which Klein says the first-generation Keen struggled with when he tested it alongside other wearable devices — may create false positives for users, meaning the device alerts a user to a movement that didn’t actually occur.

These false positives, he says, may bother some users, but not others.

“If I had issues where I was pulling out my eyebrows or I was going bald due to trichotillomania, I personally — and some I’ve spoken with — would put up with false positives,” he says. “However, I believe that there’s going to be at least some group of people who are just going to stop wearing the device because they don’t trust it.” But, he says, he’s confident these types of devices are going to get better at detecting small, specific movements. In 2019, Klein’s team conducted research involving a device prototype he developed for studying wearables’ use in diagnosing and managing BFRBs. They discovered that temperature-detecting thermal sensors are better able to detect a hand’s movement near the head than the conventional means of position tracking that the Keen, the Pavlok, and many other wearables rely on.

There was absolutely some irritation to be found among Keen users on Reddit’s t/trichotillomania and r/CompulsiveSkinPicking. While most reported having a positive experience with the device, some found the false positives too annoying to put up with.

Keen’s founder lives with trichotillomania and gave a TED Talk about her experience with the disorder and how she developed the Keen. After watching the talk, Reddit user u/PicklesandTea went out and bought the first generation of the device. “This is the first time in my life I’ve felt hopeful about overcoming Trich,” they wrote. “The bracelet takes some patience as you have to fiddle with the settings a bit. Mines not perfect, it buzzes sometimes because I’m doing similar motions when eating or driving… I’m at a point of awareness where I can count how many hairs I pull a day.”

u/5uicideboy5, however, had a more disappointing experience. “i used to have one but found that i could not train mine properly after a couple weeks and got fed up and decided to return it,” they wrote. “Personally the stress of it not working in conjunction with trying to have it recognize my pulling and buzzing randomly all the time just frustrated me.”

For most people with a BFRB, there’s probably little risk to trying out the Keen; if it doesn’t work, then it is likely not much more than a minor waste of cost and effort. And according to John Torous, MD, director of the digital psychiatry division at the Harvard-affiliated Beth Israel Deaconess Medical Center, the possibility that devices like the Keen and others like it can help is certainly there.

“I think the potential seems really high. And I think it makes sense that we can kind of pick up signals of these repetitive behaviors and help people build awareness of these behaviors and help people have triggers and alarms,” which he says can activate self-help strategies or encourage users to get help from their community. The issue, he says, is that there’s just not enough evidence, from the company or independent researchers, that devices like this can help. Right now, it’s more theoretical. “I think it’s one of those things where we think technology could be helpful — the story makes sense. But how does it work in the real world? I think we don’t fully quite yet know.”

HabitAware has neither published any of its own research, nor conducted a clinical trial, evaluating the efficacy of the Keen. In May of this year, the company completed a small feasibility trial, which is a type of study that investigates whether a particular project has any reason to continue or should be abandoned altogether. It’s also releasing an update to its firmware and gesture detecting algorithm alongside the Keen 2 launch, so new users and those with the older Keen will likely find that their product works better than before.

I’m hopeful that, as more researchers look at how devices like the Keen can help people with BFRBs, people with these compulsions will be able to find relief with the help of a wearable. Anecdotal evidence, on Reddit, at least, shows that the promise is there. As researchers like Klein, Torous, and others continue to investigate the possibilities and limits of such products, consumers will have a clearer idea of what they can and cannot expect from such devices. Because right now, we don’t really know. If you have $129 and want to augment the early stages of your BFRB treatment plan with a wearable, by all means, give it a spin! It probably won’t hurt. Just don’t expect a miracle.