Can an App Really Help Manage Your Mental Health?
Or will the proliferation of apps designed to help mental wellbeing provide an excuse for keeping mental health services underfunded?
Suffering from anxiety, depression, insomnia, or even schizophrenia? It'll probably come as no surprise that there's now an app for that. With modern life completely dominated by smartphones and tablets, innovators in the field of mental health are rushing to develop ground-breaking digital solutions to the problems in our heads. But are they any good?
As of July 2015, Apple's app store boasted 1.5 million apps, while Android users are able to choose from 1.6 million in the Google Play store. Needless to say, as with all of these apps, the tools designed to improve your mental health and wellbeing vary greatly.
Many draw on the Buddhist practice of mindfulness—the most popular of which, Headspace, boasts two million users, Gwyneth Paltrow, Emma Watson, Fearne Cotton, Jared Leto, and Arianna Huffington among them. Others, meanwhile, use techniques from more modern psychological tools like Cognitive Behavioral Therapy (CBT).
Andy Gibson is "Head Gardener" of Mindapples, a social enterprise dedicated to educating people about nurturing and nourishing their mental wellbeing. "What we're seeing is a growing interest in people wanting to take care of their minds," he says, "so I see a large number of these apps as an extension of the self-help market."
He adds: "There's an obvious extension into the app world of monitoring behavior, getting support from peers, feedback, that kind of thing." This is exactly where the Mindapples app, Moodbug, fits in: it combines a tool for tracking and monitoring your moods, similar to the kind of "mood diary" you might use in more traditional CBT, with interactions similar to a social network—where users can view their friends' moods and offer support where necessary.
There's an obvious parallel with the equally fast expanding market for fitness tracking apps like Strava or MapMyRun, where users not only log their exercise sessions, but also share them socially, liking and commenting on each other's efforts. In fact, Headspace is even marketed as "a gym membership for the mind."
"The health applications space is inundated with physical fitness apps, and people are starting to realize, due to the high pressures that life brings, that mental health is equally as important," says Ustwo's Alana Wood, who is product lead on the new app Moodnotes.
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Produced in collaboration between game developer Ustwo and the two clinical psychologists behind Thriveport LLC, Moodnotes draws on CBT and "positive psychology" approaches to help users track their moods, identify and challenge negative "thinking traps," and develop techniques for re-evaluating and modifying their thinking.
"We are already seeing that some people use it every day to log their mood. Some people just use it when they encounter a stressful situation at work, to unstick their thinking. Then we're also seeing people who use it to discover what makes them more content in life," Wood explains.
Another app, Sleepio, was co-developed by Professor Colin Espie, one of the UK's leading sleep experts, as a CBT-based tool to tackle insomnia. "Self-help is the first port of call for most people, so apps make information, education, and indeed therapy much more readily available," he says. "The dynamics of an app allows for interaction, so it can be engaging and supportive, to assist people with behavior change, but not intrusive or dominating."
Of course, the key challenges with any app are both understanding what it can and can't do for you, and knowing which apps are actually worth your time and money, and which could end up doing more harm than good. "You can't replace human contact, and the more cynical driver of [mental health apps] is obviously cost saving in healthcare," says Gibson.
"In something like mental health, where we know isolation is really bad for people's minds, it would be counterproductive to try and replace people with an app—there's still much need for nurses and peer group support. For me, it's important that apps shouldn't be used as an excuse for continuing to keep mental health services underfunded."
For Dr. Edrick Dorian, one of the clinical psychologists who makes up Thriveport, the organization behind MoodKit and Moodnotes, the potential for digital mental health tools is much more about augmenting existing therapeutic services.
"It's foolhardy for anyone to expect an app to replicate what can be done with a live professional in the room; you can't discuss any of the nuances, and of course you miss the interpersonal aspect and the feedback of a trained professional," he says.
"[An app] is certainly capable of communicating some of the education, principles, tools, and techniques that one would learn in therapy, and supplementing therapeutic services," he adds.
Likewise, Professor Espie highlights that, "One obstacle is that [the app industry] is largely unregulated, so anyone can make claims that 'this will transform your life.' What we're endeavoring to do with Sleepio is very much pioneer the evidence-based app, so GPs are more able to direct you toward things that are going to be safe and effective. The standing of the [developer] within their field is important, knowing who is actually behind it."
Likewise, Gibson adds, "With apps like Headspace, that have got a huge following, at least you know there are a lot of happy users. It's also worth knowing the free ones are often better than the paid ones, because a lot of these are made by charitable organizations or healthcare trusts for the purpose of improving health, so don't feel you've got to spend a lot of money."
Quality control is an area where the sector is now developing, albeit slowly. Research published by the University of Cambridge at the start of August found that "brain training" game Wizard helps people with schizophrenia, and Sleepio has been successfully piloted with patients affected by depression and anxiety—conditions in which sleep plays a significant role.
"The Department of Health and senior NHS people have recognized that innovation is coming from entrepreneurs, so they've set up the NHS Innovation Accelerator [to which Sleepio's co-founder Peter Hames has been appointed as a fellow], to bring in people who have done good things in an evidence-based way."
He adds: "I see [apps] as components of the new healthcare system going forward; we should see it as a great opportunity." In that spirit, both Sleepio and Moodnotes feature functions that allow GPs and psychologists to access and track their patients' progress, so the apps can be used to provide feedback in face-to-face sessions.
However, until using and recommending apps becomes mainstream within the health service, Dr. Dorian's advice for finding reputable, credible mental health apps is to use resources like the NHS health apps library. "It has a clinical team of reviewers who go through the content, inquire about the developmental history of the app and its developers, and ultimately determine whether they consider it to be both a safe and trustworthy app," he explains.
Ultimately, Professor Espie believes "the apps that really help best will be the ones that last, and the ones that really don't work will end up being just a waste of some people's time and money. The risk is that in the interim they could actually do some harm."
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