Many characteristics of the digital world–immediacy and affordability of information, massive variety of sources, and convenient communication with others–seem to directly reference the most common issues facing mental health treatment opportunities. These issues include high costs for treatment, difficult accessibility, and limited amounts of treatment sources available.
Applications (apps), that is, software accessed through a technological medium (primarily smartphones and tablets), have begun to accommodate the growing mainstream interest in mental health. These apps can attempt to aid a variety of mental illnesses, but appear to most commonly address depression, anxiety, stress disorders, bipolar disorder, eating disorders, and gambling or addiction disorders [1]. These apps can provide a therapeutic dialogue, a way to track one’s mood and behaviour, give feedback, offer motivational support, provide standardized testing for illnesses, or inform about mental illnesses. Apps can be used on their own as a less intense form of treatment, or as part of a larger treatment plan.
“[These apps] can disseminate evidence-based materials in a very accessible way when done well. Some apps created by psychologists do this very nicely. I think there’s real potential there,” says Jessica Dere, Assistant Professor, Teaching Stream in Psychology and the director of the Cultural-Clinical Psychology Lab at University of Toronto Scarborough Campus.
While the clear benefits of combining mental health treatment and the digital world may seem initially positive, in true yin and yang style, negative implications haunt these apps, primarily through an issue faced by the digital world as a whole: illegitimate claims and false information. Determining the legitimacy of these apps has become overwhelming due to their sheer numbers: there are now over 3,000 mental health apps available on Android, Apple, and Microsoft app stores[1].
“There is lots of potential, but also the possibility of negative results,” Dr. Dere says. She uses mental health apps herself as a sort of homework for her patients, and finds that many of these apps can be helpful as they employ mood and behavior tracking, a crucial aspect of many instances of Cognitive Behavioural Therapy (CBT). She primarily uses these apps as an alternative to paper handouts for this homework, but is hesitant about apps that claim to do much else.
As expected, the efficiency of these apps has been debated, which led to a 2015 study published in the journal, Evidence Based Mental Health. The journal found that in the U.K., 85% of the apps offered by the National Health Services that claimed to target symptoms of depression were not proven to be effective in any way [2]–despite their claims to legitimacy, and suggestions of effectiveness. Another study conducted in 2013 by the University of Valladolid in Spain examined documents on 3,673 commercial health apps (for both mental health and physical health), and concluded that the development of these apps were primarily inspired by promotional and financial gain, rather than the scientific motivations behind mental and physical health research [3].
Despite this, potential exists for legitimate, evidence-based apps.
The Black Dog Institute from Sydney, Australia, an institution that investigates the treatment and diagnosis of mood disorders, also studied reports on the efficiency of five mental health apps determined to be legitimate (i.e., Mobilyze!, mobiletype, DBT Coach, Mobile Stress Management, and Get Happy Program); they found that symptoms of depression, stress, and substance use were reportedly reduced, substantially even, in users [1]. Another study conducted in 2011 by the University of New South Wales’ School of Psychology examined participants interacting with the self-help app ‘myCompass,’ which involved behavior tracking and online activities based on CBT. After a six week span, “preliminary analyses found that participants’ symptoms of stress, anxiety, depression and overall psychological distress were significantly reduced… Improvements were also found in functional impairment and self-efficacy” [4].
A majority of the apps available to the public lack scientific evidence regarding their efficiency [1]. The Black Dog Institute warns: “Mental health apps have the potential to be effective and may significantly improve treatment accessibility. However… [the] public needs to be educated on how to identify the few evidence-based mental health apps available in the public domain to date” [1].
There are obvious benefits to digitizing mental health treatment, but risks of illegitimacy threaten what may be a very positive change in treatment.
By: Alexa Battler
Edited by: Veerpal Bambrah
Image by: Marian Sia
References:
[1] Donker, Tara, Katherine Petrie, Judy Proudfoot, Janine Clarke, Mary-Rose Birch, and Helen Christensen. “Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review.”Journal of Medical Internet Research 15.11 (2013). JMIR Publications. Web. 22 Feb. 2016.
[2] Leigh, Simon, and Steve Flatt. “No Proof That 85 Percent of Depression Treatment Apps Accredited by NHS Actually Work.” Evidence Based Mental Health (2015). British Medical Journal. Web. 22 Feb. 2016.
[3] Martínez-Pérez, Borja, Isabel De La Torre-Díez, and Miguel López-Coronado. “Mobile Health Applications for the Most Prevalent Conditions by the World Health Organization: Review and Analysis.” Journal of Medical Internet Research 15.6 (2013): n. pag. JMIR Publications. Web. 22 Feb. 2016.
[4] Harrison, Virginia, Judith Proudfoot, Pang Ping Wee, Gordon Parker, Dusan Hadzi Pavlovic, and Vijaya Manicavasagar. “Mobile Mental Health: Review of the Emerging Field and Proof of Concept Study.” Journal of Mental Health 20.6 (2011): 509-24. National Center for Biotechnology Information. Web. 22 Feb. 2016.
