HEALTH SENTINEL: A user’s guide to therapy on your smartphone

The development and use of mental-health mobile apps is exploding due to their quick accessibility, anonymity and little or no cost. Mental-health providers caution many mental-health apps have little or no unbiased, evidence-based research behind them. Still, those with unbiased, proven effectiveness can help bridge accessibility gaps in mental-health services for some people. This phone screen shot shows just a sampling of free mental-health apps for a variety of conditions. (Photo by Jennifer L. Boen)
The Self-help Anxiety Management, or SAM, app was created by the University of the West of England in Bristol. It offers tools and strategies to help users track and manage anxiety in an interactive platform. For example, one technique has users type their anxious thought into clouds that float away. Users can anonymously connect to others to learn how they manage anxiety, but critics of this feature say that is not always a good thing, with both positive ideas and negativity being shared. (Photo by Jennifer L. Boen)
Dr. Jay Fawver
Psychologist Zachary Adams

More than 75 percent of Americans now own a smartphone, up from just 35 percent in 2011, according to Pew Research Center studies published in 2017.

When on our smartphones, time is increasingly spent on applications, or apps, with U.S. smartphone users averaging 3 hours, 23 minutes a day using apps compared to averaging 50 minutes a day using our phones to search the Internet, reports eMarketer, a global company that tracks and analyzes digital marketplace information.

A massive app smorgasbord is at our fingertips. As of March 2017, Apple users had access to 2.2 million apps; Android users had even more options: 2.8 million apps, according to eMarketer. Among them are mental-health apps for everything from tracking symptoms and triggers of anxiety to accessing trained counselors for help with depression or other mood disorders.

For example, the Self-help for Anxiety Management (SAM) app offers anxiety-reducing strategies. If anger is the issue, What’s Up? might be a good choice. Headspace provides guided meditation; 7 Cups gives access to free, confidential chats with trained volunteer listeners; Moodtrack helps the user chart mood swings.

The U.S. Department of Veteran Affairs developed PTSD Coach to help veterans and others cope with trauma. MY3 is a suicide prevention app, … and the list could go on and on.

Most of the aforementioned apps are free. Some mental-health apps have fees after a trial period or if the user wants more in-depth services. Many apps are available that connect users to licensed therapists in real time, with the user paying a fee that is often lower than seeing a therapist.

Convenience is key. Some studies show people are more willing to admit and seek help for a mental-health issue if they can do so without a face-to-face encounter with a therapist or without scheduling and waiting for or traveling some distance to see a therapist. Help is usually 24/7.

“Indiana is a state with a profound shortage of psychiatrists,” said Dr. Jay Fawver, psychiatrist and medical director of Mind-Body Medicine with Parkview Physicians Group. “Some people are not able to see a therapist in their community or don’t have the ability to pay for therapy.” As in other areas of medicine, Fawver said technology is helping bridge these gaps in mental-health services.

Not everyone or every condition can benefit, but some evidence for the validity of effectiveness exists. Fawver cited a meta-analysis comparing internet-delivered cognitive behavior therapy (CBT) with face-to-face CBT. Published in the Journal of World Psychiatry in 2014, researchers concluded both delivery models produced equivalent treatment results for specific conditions. Guided internet CBT involves oversight and periodic involvement of a therapist.

“As psychiatrists, we’re always asking about sleep, energy and appetite,” Fawver said, noting apps enable tracking of those things, with the information digitally sent to the psychiatrist or therapist, providing what is called digital phenotyping. That enables faster intervention, he explained, which can be particularly crucial if medication needs adjusting.

A major caveat in use of mental-health apps is the lack of evidence proving their effectiveness, said psychologist Zachary Adams. He is an assistant professor of clinical psychology in the department of psychiatry at Indiana University School of Medicine-Indianapolis.

“Even though there are thousands of apps developed on mental health, behavioral health or emotional well-being, most of those don’t have direct effectiveness research tied to them,” Adams said.

Safety considerations also must be addressed, he said, not only as it pertains to when and for whom such apps are appropriate but also safety as it relates to privacy and confidentiality.

“A lot of apps don’t include very detailed information about confidentiality and data platforms. I strongly suggest people look into the privacy policy and procedures. Look at who the developers and distributors are,” Adams advised, pointing out among the most-trusted ones are those developed or evaluated by the VA or a university.

Adams, who is part of a federally funded project on developing a mobile app for teens with co-occurring mental health and substance-abuse problems, said, “As a researcher, my goal is not to prove that your app works, but to test its effectiveness.”

“I don’t think we’re at the place yet that (we have) confidence an app is going to replace the health-care provider,” Adams said. “The evidence suggests certain apps can be helpful as adjuncts to treatment, and there are also some ways mobile apps can make progress (for the patient) outside treatment.

“There’s a lot of work in educating professionals,” Adams emphasized, noting continuing education on their use is a growing demand among service providers. While no national standards for evaluating mental-health apps’ effectiveness exists as yet, Adams said the nonprofit PsyberGuide (psyberguide.org) is a good starting point for individuals seeking more information and ratings of mental health apps.

Jennifer L. Boen is a freelance writer who writes frequently about health and medicine. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of News-Sentinel.com.