How to choose a mental health app

With high demand for therapists 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 a variety of problems such as addiction, insomnia, anxiety and schizophrenia, often using tools like games, therapeutic chatbots or mood diaries. But most are unregulated. While some are considered useful and secure, others may have unstable (or non-existent) privacy policies and a lack of high-quality research showing that applications meet their marketing claims.

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

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

So how do you make an informed decision about whether to add one to your phone? We asked several experts for guidance.

In general, mental health applications can help people gain insight into how their thoughts, feelings and actions interact, said Dr. John Torous, director of the digital psychiatry department 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 geriatric psychiatry department at McLean Hospital, noted that mental health applications “can work well with physical activity goals, such as pedometers,” because exercise can help reduce anxiety and depressive symptoms.

“Similarly,” she said, “skills-based applications such as deep breathing can be helpful to anyone experiencing stress – whether stress is the result of an anxiety disorder or just circumstances.”

For some people, however, applications are not very convenient.

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

No, especially not if you have symptoms of worsening.

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

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

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

Dr. Torous offers his patients a free app called MindLAMP, which he created to improve their mental health treatments. Tracks people’s sleep patterns, physical activity, and changes in symptoms; it can also adjust the “homework” that therapists assign to their patients.

Mostly not. The Food and Drug Administration regulates a small subset of applications that provide treatment or diagnosis, or are associated with regulated medical devices. But most mental health applications are not subject to government oversight.

Therefore, some applications make unfounded marketing claims, experts warn, or worse, offer inaccurate and potentially harmful information.

“The number of products far exceeds the existing research evidence,” 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 internally by companies,” he added, rather than impartial outside groups.

In addition, there is no requirement that all wellness applications comply with the Health Insurance Portability and Liability Act, known as HIPAA, which regulates the privacy of patients ’health records.

In a recent paper, Dr. Torous and his colleagues examined regulatory gaps in digital health applications, revealing various problems that could arise, such as incorrect phone numbers to help in suicide crises. The paper also noted an earlier study that found that 29 of the top 36 depression and smoking cessation apps shared user data with Facebook or Google, but only 12 found this accurately in their privacy policies.

And in March, a study concluded that an app created to help people with schizophrenia had nothing better than a placebo (in this case, a digital countdown).

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

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

“As a clinician who has been using applications in care for more than five years, it has always been difficult to understand which applications to tailor to patients,” said Dr. Torous. “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 highest ratings, try to make an informed decision about which app would suit you best, he added.

One place to start research is the Mind Apps website, created by clinicians at Beth Israel Lahey Health in Massachusetts. It has reviewed more than 600 applications and is updated every six months. Reviewers look at factors such as cost, security and privacy concerns and whether the application is supported by research.

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

While MindApps and One Mind Psyberguide provide an overview of the app’s privacy policy, you may want to study the details for yourself.

See what types of information he collects, his security measures and whether he sells information to third parties or uses it for advertising, said Dr. Collier.

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

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

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

The answer to this question may depend on when you ask. But all the experts praised the mental health applications developed by the federal government, such as the PTSD Coach; Mindfulness Coach; and CPT Coach, which is for people who practice cognitive processing therapy with a professional mental health provider.

These applications are not only well studied, but also free, with no hidden costs. They have excellent privacy policies and state that personal data will never be shared with a third party.

In addition to these applications, Dr. Collier recommends:

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

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

    For more suggestions, check out this list of applications on the University of California, San Francisco Department of Psychiatry and Behavioral Sciences website. The list, which was made in agreement with others. Schueller, includes several free options.

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