Given the explosion of knowledge about psychiatric disorders, our workshop and online platform (codingthemind.org) will delineate how a cognitive sciences and neuroscience approach can inform the selection, operationalization, and design of digital health technology to intervene in processes hindering wellbeing worldwide.

Approximately 91 percent of the world's youth live in low-and middle-income countries (LMICs), and a majority use mobile phones. The delivery of health innovation via mobile technology (mHealth) has the potential to predict and intervene in disease processes that hinder their wellbeing. Yet the absence of theoretical rigor in these efforts too often results in regression to a mechanistically agnostic black-box approach, yielding tools that are neither generalizable nor scalable. Given advances in our understanding of disease etiology and phenomenology, this workshop aims to explore how an interdisciplinary - neuroscience and cognitive science - approach can inform the selection, operationalization, and design of digital health technologies amenable to real-time monitoring, which in turn can translate to better prediction and improvement of health outcomes.

The idea for this workshop was motivated by three imperatives. First, over 165,000 healthcare apps are currently available for consumers to directly monitor their physical and mental health {Torous:2015gx}. Their accessibility, affordability, and availability are primary reasons for the call to extend mHealth to low- and middle-income countries {Akter:2010tm, Price:2013kt, Hall:2014cc, Onnela:2016di}. For every 5,300 people in LMICs, there are 2293 mobile phones, but only 11 hospital beds {Akter:2010tm}. Health inequities are growing, as disparities in living conditions widen both within and between countries {Marmot:2012gi}. Amid escalating inequities, mHealth promises to transcend sociocultural and geographical boundaries to deliver biomedical advances to bedsides. Yet, realization of mHealth's promise is dampened by the fact that most mHealth interventions do not emerge from or feed back into our growing understanding of disease pathogenesis or how different theories of mind inform human behavior {Tomlinson:2013eu}.

Because the etiology of many diseases can be traced to the first two decades of life {Gore:2011bm} and, in particular, early life adversity, this workshop focuses on young people and trauma. The key questions is: How can a combined neuroscience and cognitive science approach inform the design of mHealth initiatives that are able to (1) discern transdiagnostic signatures of disease pathogenesis, trajectory, and maintenance; (2) characterize the when-where-who of psychosocial and structural vulnerability within biologically and ecologically estimable parameters; and (3) advance wellbeing across the globe through evidence-based practice?

Second, adolescence has emerged as a "sensitive period" for sociocultural learning. Neuroscientists have identified a number of structural and functional brain changes that occur during this developmental period and that are associated with enhanced cognitive flexibility and attention to social exclusion, reward, and peer evaluation {Crone:2012bx, vanDuijvenvoorde:2008gp, Silk:2014ky, Chein:2010jp, Rose:2006iy, Blakemore:2014gz}. Gradients of opportunities and risks are also locatable within the specific developmental niches that adolescents occupy; these gradients constrain capacities or capabilities ranging from educational attainment to cognitive development {Lende:2012em}. The variability of stress exposure, in particular, translates into differential outcomes based on what we know about the body's acute stress response and the implications of prolonged or recurrent stress exposure on metabolic, cardiovascular, and immunological outcomes {Vaessen:ve, Sapolsky:2000ht, Dickerson:2004kv}. So too, the core effects of the texture of daily experiences appear traceable in facial, physiological, and neural signatures {WilsonMendenhall:2013fu}, permeating perceptions of and responses to threat {DeSteno:2013bx, Wormwood:2015kj}.), However heterogeneous the experiences, much of the response to trauma seems to follow a common pathway from a neuroscience perspective, based on our understanding of fear conditioning, neural stress circuitry, and the encoding and retrieval of memories {Ross:2017fi}. The effects of psychosocial or pharmaceutical interventions also seem to follow recognizable pathways relating to behavior activation, reward prediction, and pharmacodynamics and pharmokinetics.

The third imperative relates to time, that is, the need for understanding the present in order to predict the future. Ecological theories and metaphors evoked within the social sciences, ranging from "developmental niche" to "structural violence," support the argument that these observed interrelations are not spontaneous, but systematic, temporally consistent across everyday and intergenerational timescales {Worthman:2010fp, Farmer:2004bd, Kuzawa:2011bk}. Further, concepts from philosophical cognitive science such as embodiment and enactment suggest a continuous interplay between brain, mind, behavior, and environment, and the reverberation of such interactions in and through health outcomes, revealing "the taken-for-granted, implicit assumptions of regnant theories, and … the fault lines in the everyday construction of reality" (Kirmayer & Ramstead, 2017:5). Thus, an embodied, enactive approach provides a means of understanding how the social, cultural ecology scaffolds perception, experience, and the etiology and trajectory of trauma-associated outcomes.

Digital health dissects the "film of daily life" into measurable, intervene-able moments {Wichers:2011kd}. Rather than post hoc explanations or complementary but isolated qualitative data, phenomenology, embodiment, and enactment become the very parameters to be operationalized and estimated. Biosensors, ecological momentary assessments, and passive monitoring generate multi-dimensional, person-centered data that can situate the magnitude and duration of bodily and emotional reactivity to social contexts (EMA), location (GPS), and networks of events that precede and follow them. Thereby, a spike in heart rate becomes tied to what is known about the person's past (e.g., history of stress exposure), present (e.g., the utterances, the imminent stakes), and future (e.g., symptoms triggered). The trajectory of the life-course is thus unraveled and predicted by the everyday fragments that constitute them. Time series analysis, latent growth curve models, and an increasing number of novel approaches enable modeling of intra- and inter-individual variability with increasing granularity and precision. The hardware and software at hand places onus and opportunity for researchers to translate what is known within the laboratory or clinic into the flow of everyday life to capture the dynamic evolution of risk and resilience through diverse disease states, interventions, and cultural and social contexts.

The workshop will advance the field of innovative digital health by leveraging cognitive sciences and neuroscience to inform:

• Characterization of the bases of trauma response;
• Selection of the types of technology suited for the problem specified;
• Selection and operationalization of key psychophysiological, cognitive, and psychological parameters for routine outcome monitoring;
• Determination of frequency and timing of ecological momentary assessments to discern fluctuation in key parameters, variation in cognitive and emotional processing, and looping effects meaningful for the prediction of future behavioral or clinical outcome(s) while accounting for placebo effects;
• Design/selection of tools and covariates to disentangle the effects of social and physical environment on key parameters;
• Design of alert systems to notify physicians and support networks for person-centered care;
• Design/selection of measurement technology, user analytics, and field trials to assess impact;
• And integration with open mHealth architecture that is sustainable, scalable, and amenable to user input;

The two-day workshop will consist of an open conference on the first day and closed working group session on the second day. The first day will begin with a series of presentation by the speakers, open to Emory faculty and students, and end with a poster session by students. Ample time will be built in for networking. The second day will consist of a closed session for speakers to produce recommendations for the named parameters and provide suggestions for 1-2 pilot studies, which could be funded by the Health Innovation Program or Global Health Institute at Emory, and the Marion E. Kenworthy-Sarah H. Swift Foundation.