Case study / by Ziryan Aziz
The digitalisation of psychological therapy and wellbeing resources undoubtedly means an increasing proportion of the public will have access to some form of psychological support. However, as the influence of technology creeps further into our daily lives, questions are being asked of how effective these apps are, what evidence supports them, and whether app culture could render traditional therapy a thing of the past. Ziryan Aziz investigates.
Today, there is an app for just about everything, and mental health is no exception. It is estimated there are between 10,000 to 20,000 self-help apps across the various app stores, with that number continuing to grow.
The span of varying support these apps provide is staggering, and there are several popular mental health apps which top the charts for most downloaded in the field of self-help. Those which have the highest downloads support functions for cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), goal setting, diaries, managing depression and anxiety, and assisting users with managing sleeping patterns.
Are there benefits?
With the World Health Organisation (WHO) predicting that 1 in 4 people globally will be affected by a mental health illness at some point in their life, and with over 6.6 billion people across the world expected to own a smartphone in 2022, clinically approved apps feel like a logical solution to combat the growing demand for mental health services.
And it certainly feels like the UK is attempting to capitalise on the opportunity. The NHS has adopted mental health apps as a cost-effective solution to the growing demand in mental health services, and the shortage of mental health professionals. It has even provided a list of recommended apps for patients to use.
Despite such an official backing though, at least in the UK, the use of these apps continues to divide opinion, and mostly, concerns are around how well apps work at dealing with mental health issues.
Some specific examples of apps that claim to be effective include Woebot, an app which allows users to interact with a chat-bot via text, which has been shown to deliver measurable improvements in mood for users with anxiety, depression, postpartum depression, and even substance abuse. Wysa, another app which also features a conversational artificial Intelligence agent to assist with anxiety and depression, has been shown to also improve symptoms of major depression. The NHS-approved Catch It has been shown to reduce the intensity of negative moods and increased intensity of good moods. Many of the NHS approved apps are backed by evidence-based research.
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A replacement for therapy?
Even with the degree of positive results seemingly in favour of mental health apps, there remains a degree of scepticism amongst some mental health professionals as to whether they are in fact a step in the right direction.
One of the biggest areas of concern is that many of the apps out on the market lack the background science in how they are created and modelled, and there is little to no testing against actual research.
A report from Nature Digital Medicine, which investigated the effectiveness of 73 mental health apps across a range of psychological conditions, found that 64% of the apps claimed to be clinically effective – yet none of the apps had certification or accreditation to support their claims. Only one app included a citation to research.
Many mental health apps also lack interconnectivity, i.e., they contain information that is bound to the app itself and cannot be shared elsewhere. Coupled with the issue that the majority of these apps are not linked to a patient’s electronic health records, this means that a user’s progress cannot be tracked or compared against their own progress from professional support. This would be important to contextualise how far a patient has come with regards to their progress and would be a factor in determining future treatment plans.
More broadly, there is a potential risk of discouraging users – particularly those who are using apps as a first step towards managing their mental health issues – from seeking professional support in the future if their experience using an app is unfulfilling or outright bad.
Furthermore, it’s worth noting that whilst there is somewhere between 10,000 to 20,000 mental health apps on the market, and that figure is growing, roughly 90% of users can be attributed to two apps – Headspace & Calm, both of which focus on mindfulness-based practices.
A bright future ahead
However, many clinicians and mental health professionals are not as worried about the negative effects of these apps as they are excited by the potential benefits they could bring.
Some argue that apps can be inspiring for users to seek professional support, especially if the app itself is linked to a healthcare body. Many also argue in favour of apps being used outside of therapy, acting as a complementary tool to traditional tried-and-tested therapies. And of course, there is always the argument to be made of patient access – with so many of us owning a smartphone or an additional technology that can make use of apps, a healthcare system that utilises apps to tackle mental health issues feels like an inevitability.
There are of course many areas that remain to be improved. The current number of apps that lack the backing of scientific research and credentials should worry users and professionals alike. But with such a wide scope of various psychological and physiological conditions these apps attempt to provide support for, the potential for these apps to become a staple of common treatment is looking increasingly like a reality.