How to Choose a Mental Health App

With high-demand therapists and long waiting lists that make 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 such as games, therapy chatbots, or mood monitoring diaries. But most are unregulated. While some may be considered useful and secure, others may have unstable (or non-existent) privacy policies and a lack of high-quality research that demonstrates that applications live up to their marketing claims.

Stephen Schueller, CEO 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 Medicines eased its requirements for digital psychiatric products by 2020.

It is difficult to determine the exact number of mental health apps available, but a 2017 estimate said 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 applications would reach $ 500 million by 2022.

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

In general, mental health apps can help people learn about 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 that patients learn during therapy, he added.

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

“Similarly,” he said, “applications that teach skills such as deep breathing can be useful for anyone experiencing stress, whether it’s the result of an anxiety disorder or just circumstances.”

For some people, though, the apps don’t fit very well.

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

No, especially not if you have harmful symptoms.

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

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

“It could be this openness to thinking about‘ Maybe I should seek more professional help, ’” he said.

Dr. Torous offers his patients a free app called MindLAMP, which he created to increase their mental health treatments. It tracks people’s sleep patterns, physical activity, and changes in symptoms; you can also customize the “homework” that therapists give 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 well-being applications are not subject to government oversight.

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

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

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

In a recent article, Dr. Torous and colleagues looked at regulatory gaps in digital health applications, revealing a number of issues that could arise, such as inaccurate phone numbers for suicide crisis helplines. The paper also highlighted a previous study that found that 29 of the top 36 applications for depression and smoking cessation shared user data on Facebook or Google, but only 12 accurately revealed this in their policies. of privacy.

And in March, a study concluded that an app created to help people with schizophrenia didn’t work better than a placebo (in this case, a digital countdown timer).

“All of these applications that claim to be effective in early or preliminary or feasibility studies should probably be studied with higher quality science,” Dr. Torous said.

Finally, just because an app is popular in the online marketplace doesn’t mean it’s more secure or more effective.

“As a doctor who has used applications for care for more than five years, it has always been difficult to understand which applications were tailored to patients,” Dr. Torous said. “You really have to think about how we can respect people’s backgrounds, preferences, and individual needs.”

Instead of looking for the “best app” or the one with the highest scores, try to make an informed decision about which app would work best for you, he added.

One place to start researching is the Mind Apps website, which was created by Beth Israel Lahey Health doctors in Massachusetts. It has reviewed over 600 applications and is updated every six months. Reviewers observe factors such as cost, security, and privacy concerns and whether the application is compatible with the investigation.

Another website, One Mind PsyberGuide, evaluates health applications 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.

Although MindApps and One Mind Psyberguide provide an overview of an app’s privacy policy, you may want to go into more detail.

See what kind of information it collects, its security measures, and whether it sells information to third parties or uses information for ads, Dr. Necklace.

According to a 2019 study, less than half of mobile apps for depression even have a privacy policy, and most privacy policies are provided only 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 your data or how it’s being used,” said study lead author Kristen O’Loughlin. , postgraduate research assistant at the Institute. Virginia Commonwealth University School of Medicine.

Choose your app based on available information and your own level of convenience with the disclosure of personal information, he added.

The answer to this question may depend on who you ask. But all the experts spoke highly of the welfare applications developed by the federal government, such as 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 claim that personal information will never be shared with any third party.

In addition to these applications, Dr. Collier recommends:

  • Breathe2Relax (an app designed by a U.S. Department of Defense agency to teach abdominal breathing)

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

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

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