How to Choose a Mental Health App

With therapists in high demand and long waiting lists making it difficult to find a provider, using a mental health app can seem like a tempting and relatively inexpensive way to get help.

These apps claim to help with issues as varied as addiction, insomnia, anxiety and schizophrenia, often using tools like games, therapeutic chatbots or mood tracking logs. But most are unregulated. While some are considered useful and safe, others may have weak (or non-existent) privacy policies and a lack of high-quality research demonstrating that apps live up to their marketing claims.

Stephen Schueller, executive director of One Mind PsyberGuide, a nonprofit project that reviews mental health apps, said the lack of regulation has created a “Wild West,” which was exacerbated when the Food and Drug Administration relaxed its requirements for digital psychiatry products in 2020.

It is difficult to determine the exact number of mental health apps available, but a 2017 estimate indicated that there were at least 10,000 available for download. And these digital products become a lucrative business. Late last year, Deloitte Global predicted that global spending on mobile mental health apps would reach nearly $500 million in 2022.

So how do you make an informed decision on whether to add one to your phone? We sought advice from several experts.

In general, mental health apps can help people better understand how their thoughts, feelings and actions interact with each other, said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical. Center. They can also help facilitate the skills patients learn during therapy, he added.

Dr. Stephanie Collier, director of education in the division of geriatric psychiatry at McLean Hospital, noted that mental health apps “can work well alongside physical activity goals, such as step counters,” because exercise can help reduce anxiety and depressive symptoms.

“Similarly,” she said, “apps that teach skills like deep breathing can be helpful to anyone suffering from stress, whether the stress is the result of an anxiety disorder or simply circumstances.” .

For some people, however, the apps don’t quite fit.

Apps work best when people are motivated and have mild illness, Dr Collier said. “People with moderate or severe depression may not be motivated enough because of their illness to complete modules on a mobile app.”

No, and especially not if you have disabling symptoms.

“These are not stand-alone treatments,” Dr. Collier said. “But they can be effective when used in tandem with therapy.”

Ideally, mental health apps teach skills or provide education, said Vaile Wright, senior director of healthcare innovation at the American Psychological Association.

“It could be this opening to think about, ‘Maybe I should seek more professional help,'” she said.

Dr. Torous offers his patients a free app called MindLAMP, which he created to augment their mental health treatments. It tracks people’s sleep patterns, physical activities, and symptom changes; it can also customize the “homework” that therapists give to their patients.

For the most part, no. The Food and Drug Administration regulates a small subset of apps that provide treatment or diagnosis, or are associated with regulated medical devices. But most mental wellness apps are not subject to government oversight.

Thus, some apps make unsubstantiated marketing claims, warn experts, or even worse, offer inaccurate and potentially dangerous information.

“The number of products far exceeds the research evidence available,” said Dr. Schueller, who is also a clinical psychologist and associate professor at the University of California, Irvine. “Unfortunately, much of the research that exists in this area is done in-house by companies,” he added, rather than by impartial outside groups.

Also, not all wellness apps need to comply with the Health Insurance Portability and Accountability Act, known as HIPAA, which governs the privacy of health records. of a patient.

In a recent paper, Dr. Torous and colleagues looked at regulatory gaps in digital health apps, revealing various issues that could arise, such as inaccurate phone numbers for suicide crisis helplines. The document also highlighted an earlier study that found that 29 of the 36 top-ranked apps for depression and smoking cessation shared user data with Facebook or Google, but only 12 disclosed it accurately in their policies. confidentiality.

And in March, a study concluded that an app created to help people with schizophrenia worked no better than a placebo (in this case, a digital countdown).

“All of these applications that claim to be effective in preliminary or preliminary or feasibility studies should probably study themselves with better science,” Dr. Torous said.

Finally, just because an application is popular in the online market does not mean that it will be safer or more effective.

“As a clinician who has been using healthcare apps for over five years, it has always been difficult to understand which apps fit for patients,” Dr. Torous said. “You really have to think about how we can respect people’s individual backgrounds, preferences and needs.”

Instead of looking for the “best app” or the one with the most ratings, try to make an informed decision on which app would be best for you, he added.

One place to start research is the Mind Apps website, which was created by clinicians at Beth Israel Lahey Health in Massachusetts. It has reviewed over 600 apps and is updated every six months. Reviewers look at factors such as cost, security and privacy issues and whether the app is backed by research.

Another website, One Mind PsyberGuide, rates health apps for credibility, user experience, and transparency of privacy practices. The project, which is affiliated with the University of California at Irvine, has more than 200 applications in its database, and each is reviewed annually.

Although MindApps and One Mind Psyberguide both provide an overview of an app’s privacy policy, you might want to dig into the details yourself.

Look at what types of information it collects, its security measures, and whether it sells information to third parties or uses information for advertisements, Dr. Collier said.

According to a 2019 study, less than half of mobile apps for depression even have a privacy policy, and most privacy policies are only provided after users enter their data.

“It’s no wonder some people have reservations about using mobile apps like this when you don’t know if or how your data is being used,” said the study’s lead author. , Kristen O’Loughlin, graduate research assistant at the Virginia Commonwealth University School of Medicine.

Choose your application based on the information available and your own level of comfort with disclosing personal information, she added.

The answer to this question may depend on who you ask. But all the experts spoke highly of federally developed mental wellness apps like PTSD Coach; Mindfulness coach; and CPT Coach, which is for people who are doing cognitive processing therapy with a professional mental health care provider.

These apps are not only well researched but also free with no hidden charges. They have excellent privacy policies and state that personal information will never be shared with any third party.

In addition to these applications, Dr. Collier recommends:

  • Breathe2Relax (an app designed by an agency of the US Department of Defense to teach abdominal breathing)

  • Virtual Hope Box (an app produced by the Defense Health Agency that offers support in emotional regulation and stress reduction)

    For more suggestions, check out this list of apps on the University of California San Francisco’s Department of Psychiatry and Behavioral Sciences website. The list, which was created in consultation with Dr. Schueller, includes several free options.

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