Search for “stress”, “depression”, “anxiety”, or “mental health” in the app store on your mobile device and you are confronted with a bewildering array of options. Some apps claim to track your mood over time, while others claim to “cure” your mental ill health with hypnosis.
Apps hold amazing potential as mental health and wellbeing tools. You can carry them everywhere, engage with them in real time as you’re experiencing distress, and interact with them in a completely different way to other self-help tools. But it is important to know which apps you can rely on for good support, and which might even do you harm.
There is no current accreditation system for apps designed to improve or support mental health. And while some respectable organisations have lists of recommended apps, such as ReachOut.com and eMHPrac, very few of these apps are supported by experimental evidence. This means there is no way of knowing whether they actually help or not.
Many mental health apps are designed for very specific purposes. For example, ReachOut WorryTime is a fantastic app for practising the therapeutic technique of “allocated worry time”, where the user sets aside a designated time in their day for actively worrying, enabling them to reduce the amount of worrying they do throughout the rest of the day.
While this is a great technique for people who want to reduce the time they spend worrying, it is not well suited for users who have other mental health and wellbeing goals, such as reducing incidence of guilty low moods, or challenging unhelpful thoughts.
Mental health apps don’t promise to be a replacement for professional help, but can be useful tools in the treatment of subclinical problems (such as everyday anxious feelings and low moods) and the prevention of clinical problems (such as depression and anxiety disorders). Some psychologists or mental health clinicians use apps in addition to the work they do with clients and patients.
So before you set out to navigate the quagmire of available mental health apps, what should you keep in mind?
1. Does it use evidence-based techniques?
While there are many, many different types of psychological therapy, cognitive behavioural therapy, or CBT, has been shown through consistent research results to be an effective treatment for anxiety, depression, and a range of other psychological problems.
A growing body of evidence also shows that internet-based CBT interventions are reliably effective. When choosing an app, look for mentions of CBT or psychologists endorsing the app as using evidence-based practices, as these have the greatest chance at being effective.
2. Does it address more than one symptom or issue?
There is a lot of research showing mental health issues often co-exist, and share many common factors that can be dealt with concurrently. For example, the rates of overlap between anxiety disorders and depression are extremely high, with some statistics showing that 90% of people diagnosed with anxiety disorders also experience significant depression, and 85% of people diagnosed with depression problems also experience significant anxiety.
Finding an app that addresses mental health and wellbeing broadly can be a way of making sure the app has use no matter what you’re going through.
3. Do you tell the app how you’re feeling, what you’re thinking, or what you’re doing?
Apps that ask you to record your thoughts, emotions, and/or behaviours allow you to track these factors over time.
Reflecting on these entries at a later date can enable insight into helpful or unhelpful patterns and empower you to make changes.
This concept is related to CBT.
4. Does the app recommend activities that are non-technology-based and linked to the problems you’ve reported?
Once you’ve told the app about your feelings, thoughts, and/or behaviours, the app should be able to recommend something in return. A recommendation of a helpful activity can help you cope, boost your resilience, and improve your mood.
If these activities are not based on technology it can encourage engagement with other people and with the outside world. Many apps or games can serve as distractions from psychological distress, which may be helpful temporarily, but learning coping behaviours that involve engagement outside of the digital world can have longer-term benefits.
5. Can you use the app in real time, as you’re experiencing distress?
One of the great advantages of smartphone apps is that you can use them in almost any setting, including when you are facing a particularly anxiety-provoking or distressing situation.
If an app can help you during these situations, there’s a higher likelihood you’ll learn effective coping strategies and you’ll be able to deal better with future situations.
Interventions that don’t offer this interactivity and require you to complete long lessons may be better suited to computer or internet-delivered programs rather than smartphone apps.
6. Is there good experimental evidence to show the app’s effectiveness?
This may be hard to assess when downloading an app, but apps that do have this experimental evidence often proudly advertise it. While some experiments have been done on several available apps, these are usually uncontrolled, meaning there is no condition to compare the app against.
This is a relatively low quality of evidence because the placebo effect of downloading a mental health app or being involved in research may be quite strong.
The high quality evidence for any health or mental health treatment comes from randomised controlled trials, where research participants are randomly allocated to different groups using different interventions.
While some randomised controlled trials on mental health apps have been completed, no currently available anxiety or depression apps have published randomised controlled trial studies backing them up. However, in the coming years this will hopefully be addressed by researchers and some apps will have randomised controlled trial evidence.
7. Do you like it?
This may sound like an odd recommendation, but it’s important to note an app will only be effective if you use it, and you are probably more likely to use something you enjoy using.
So if you don’t like the look of the app, don’t like the language it uses, or don’t like the things it asks you to do, it’s probably best finding another one.
Apps to avoid include any that make bold claims (like “curing” depression), any that mention hypnosis (which has very limited evidence), and any purely testing apps that merely provide screening tools for clinical disorders.
Monash University is currently researching mental health and wellbeing apps and is looking for participants for a randomised controlled trial. You don’t need to be experiencing a mental health issue to participate, but you will need to be over 13 years old and own an iPhone.
Authors: David Bakker, Doctor of Clinical Psychology Candidate, Monash University