How to choose a mental health application

With a high demand for therapists and long waiting lists challenging 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 a variety of problems such as addiction, insomnia, anxiety and schizophrenia, often using tools such as games, therapeutic chatbots or mood diaries. But most are unregulated. While some are considered useful and safe, others may have unstable (or non-existent) privacy policies and a lack of high-quality research showing that applications meet their marketing requirements.

Stephen Schuler, executive director of One Mind PsyberGuide, a nonprofit project that reviews mental health applications, said the lack of regulation has created a “Wild West” that has worsened as the Food and Drug Administration loosens its digital requirements. psychiatric products in 2020

It is difficult to determine the exact number of available mental health applications, but an estimate from 2017 says that there are 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 nearly $ 500 million in 2022.

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

In general, mental health applications can help people get an idea of ​​how their thoughts, feelings, and actions interact, said Dr. John Torus, director of digital psychiatry 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 at McLean’s Geriatric Psychiatry Department, said mental health applications “can work well with physical activity goals, such as step counters”, because exercise can help reduce of anxiety and depressive symptoms.

“In the same way,” she said, “applications that teach skills such as deep breathing can be useful for anyone experiencing stress – whether the stress is the result of an anxiety disorder or just a circumstance.”

For some people, however, the applications are not very suitable.

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 application.”

No, and especially not if you have harmful symptoms.

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

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

“This may be what makes me think about” Maybe I should seek more professional help, “she said.

Dr. Torus offers his patients a free app called MindLAMP, which he created to increase their mental health treatment. It tracks people’s sleep patterns, physical activity, and changes in symptoms; it can also personalize the “homework” that therapists give to their patients.

For the most part not. The Food and Drug Administration regulates a small subset of applications that provide treatment or diagnosis, or are related to regulated medical devices. But most mental health applications are not subject to government oversight.

In this way, some applications make unsubstantiated marketing claims, warn experts, or worse, offer inaccurate and potentially harmful information.

“The number of products far exceeds the evidence from existing research,” said Dr. Schuyler, 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, not impartial outside groups.

In addition, not all wellness applications are required to comply with the Health Insurance Portability and Accountability Act, known as HIPAA, which governs the confidentiality of patient health records.

In a recent paper, Dr. Torus and colleagues explored regulatory gaps in digital health applications, revealing various problems that could arise, such as inaccurate phone numbers for suicide crisis helplines. The paper also highlights an earlier study that found that 29 of the top 36 depression and smoking cessation apps share user data with Facebook or Google, but only 12 revealed just that in their privacy policies.

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

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

Finally, just because an application is popular in the online market does not mean that it will be safer or more effective.

“As a clinician who has used care applications for more than five years, it has always been difficult to figure out which applications to combine with patients,” said Dr. Torus. “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 highest ratings, try to make an informed decision about which app would be best for you, he added.

One place to start the study is the Mind Apps website, which was created by clinicians at Beth Israel Lahey Health in Massachusetts. It has reviewed more than 600 applications and is updated every six months. Reviewers consider factors such as cost, security and confidentiality concerns and whether the application is supported by research.

Another website, One Mind PsyberGuide, evaluates health applications for credibility, user experience, and transparency of privacy practices. The project, which is linked to the University of California, Irvine, has more than 200 applications in its database and each is reviewed annually.

Although both MindApps and One Mind Psyberguide provide an overview of the app’s privacy policy, you may want to delve into the details yourself.

See what types of information it collects, security measures, and whether it sells information to third parties or uses information for advertising, Dr. Collier said.

According to a 2019 study, less than half of mobile depression apps even have a privacy policy, and most privacy policies are only provided after users enter their data.

“It’s no wonder that some people have reservations about using mobile apps like when you don’t know if and how your data is being used,” said lead author Kristen O’Loughlin, a graduate research assistant at Virginia Commonwealth University School of Medicine. .

Choose your app based on available information and your own level of comfort by disclosing personal information, she added.

The answer to this question may depend on who you ask. But all experts speak loudly about federal health applications developed by the federal government, such as PTSD Coach; Attention Trainer; and CPT Coach, which is for people who practice cognitive therapy with a professional mental health provider.

These applications are not only well researched, but also free, with no hidden costs. They have excellent privacy policies and state that personal information will never be shared with a third party.

In addition to these applications, Dr. Collier recommends:

  • Breathe2Relax (application created by an agency in the US Department of Defense to teach abdominal breathing)

  • Virtual Hope Box (an application developed by the Defense Health Agency that offers support for emotional regulation and stress reduction)

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

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