With in-demand therapists and long waiting lists making it challenging to find a provider, it can seem like a tempting and relatively inexpensive way to get help using an app for mental health.
These apps claim to help with such diverse issues as addiction, insomnia, anxiety and schizophrenia, often by using tools like games, therapy chatbots or mood-recording diaries. But most are unregulated. While some are considered useful and secure, others may have appalling (or non-existent) privacy policies and lack of high-quality research showing that apps live up to their marketing requirements.
Stephen Schueller, CEO of One Mind PsyberGuide, a nonprofit project reviewing apps for mental health, said the lack of regulation has created a “wild west” that worsened as the Food and Drug Administration loosened its requirements for digital psychiatric products in 2020.
It is difficult to pinpoint the exact number of mental health apps available, but an estimate from 2017 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 worldwide spending on mobile mental health applications would reach $ 500 million by 2022.
So how do you make an informed decision about whether or not to add one to your phone? We have asked several experts for guidance.
Who can benefit from a mental health app?
In general, mental health apps can help people gain insight into how their thoughts, feelings, and actions interact with each other, said Dr. John Torous, Director of the Digital Psychiatry Department at Beth Israel Deaconess Medical Center. They can also help ease the skills that patients learn during therapy, he added.
Dr. Stephanie Collier, director of education in the geriatric psychiatry department at McLean Hospital, noted that mental health apps “can work well with physical activity goals, such as pedometers,” because exercise can help reduce anxiety and depressive symptoms.
“Similarly,” she said, “apps that teach skills such as deep breathing can be useful for anyone experiencing stress – whether stress is the result of an anxiety disorder or just circumstances.”
For some people, though, apps are not a good fit.
Apps work best when people are motivated and have mild illness, Dr. Necklace. “People with moderate or severe depression may not have sufficient motivation due to their illness to complete modules on a mobile app.”
Can mental health apps become a substitute for therapy?
No, and especially not if you have debilitating symptoms.
“These are not independent treatments,” said Dr. Necklace. “But they can be effective when used in conjunction with therapy.”
Ideally, mental health apps teach skills or provide education, said Vaile Wright, senior director of health innovation at the American Psychological Association.
“It could be this opening to think of ‘Maybe I should seek more professional help,'” she said.
Dr. Torous offers his patients a free app called MindLAMP, which he created to improve their mental health treatments. It tracks people’s sleep patterns, physical activities and changes in symptoms; it can also adapt the “homework” that therapists give their patients.
Have these apps been screened by a regulator?
Mostly no. The Food and Drug Administration regulates a small subset of apps that provide treatment or diagnosis or are associated with regulated medical devices. But most mental wellness apps are not subject to public oversight.
Thus, some apps make unsubstantiated marketing claims, experts warn, or worse, offer inaccurate and potentially harmful information.
“The number of products far exceeds the research evidence out there,” said Dr. Schueller, who is also a clinical psychologist and associate professor at the University of California, Irvine. “Unfortunately, much of the research that exists in this area is done internally by companies,” he added, rather than independent external groups.
In addition, there is no requirement that all wellness apps comply with the Health Insurance Portability and Accountability Act, known as HIPAA, which regulates the privacy of a patient’s health records.
In a recent paper, Dr. Torous and his colleagues regulatory gaps in digital health apps and revealed various issues that could arise, such as inaccurate phone numbers for suicide crisis helplines. The newspaper also highlighted a previous study that found that 29 of the 36 top-ranked apps for depression and smoking cessation shared user data with Facebook or Google, but only 12 revealed this exactly in their privacy policies.
And in March, a study concluded that an app created to help those with schizophrenia did not work better than a placebo (in this case, a digital countdown timer).
“All of these apps that claim to be effective in early or preliminary or feasibility studies are likely to study themselves with higher quality science,” said Dr. Torous.
Lastly, just because an app is popular in the online marketplace, does not mean that it will be more secure or more effective.
How do you go about choosing one?
“As a clinician who has been using apps in care for well over five years, it was always difficult to understand which apps should match patients,” said Dr. Torous. “You really have to think about how we can respect people’s individual backgrounds, preferences and needs.”
Instead of looking for the “best app” or the one with the most ratings, try to make an informed decision about which app would be the best match for you, he added.
One place to start researching is the Mind Apps website, which was created by clinicians at Beth Israel Lahey Health in Massachusetts. It has reviewed more than 600 apps and is updated every six months. Reviewers look at factors such as concerns about cost, security and privacy, and whether the app is supported by research.
Another site, One Mind PsyberGuide, evaluates health apps for credibility, user experience, and transparency in privacy practices. The project, which is affiliated with the University of California, Irvine, has more than 200 apps in its database, and each of them is reviewed annually.
What should you look for in an app’s privacy policy?
Although MindApps and One Mind Psyberguide both present an overview of an app’s privacy policy, but it may be a good idea to dig into the details yourself.
Look at what kind of information it collects, its security measures, and whether it sells information to third parties or uses information for advertising, said Dr. Necklace.
According to a 2019 survey, 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 do not know if or how your data is being used,” said study lead author Kristen O’Loughlin, a trained research assistant at Virginia Commonwealth University School of Medicine.
Choose your app based on the information available and your own level of comfort in revealing personal information, she added.
Which apps are reputable?
The answer to this question may depend on who you are asking. But all the experts talked a lot about the mental wellness apps developed by the federal government, such as the PTSD Coach; Mindfulness Coach; and CPT Coach, which is for people who practice cognitive processing therapy with a professional psychiatric provider.
These apps are not only well researched but also free of charge with no hidden costs. They have excellent privacy policies and say that personal information will never be shared with a third party.
In addition to these apps, Dr. recommends Necklace:
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Breathe2Relax (an app designed by a U.S. Department of Defense agency to teach stomach breathing)
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Virtual Hope Box (an app produced by the Defense Health Agency that offers support for emotional regulation and stress reduction)
For more suggestions, check out this list of apps at the University of California, San Francisco’s Department of Psychiatry and Behavioral Sciences. The list, which was created in consultation with Dr. Schueller, contains several free options.