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Silicon Valley thinks they have a solution for everything. Including, apparently, the
fact that not everyone around the world who needs mental health care gets it.
And at this very moment, there are thousands of mental health apps out there claiming to
do everything from easing insomnia to treating PTSD symptoms.
But as you might expect, many of the apps out there aren’t backed by evidence. But
mental health experts are hoping to change that.
In theory, getting therapy over the internet can be effective.
After all, research suggests a given treatment’s effectiveness comes down less to the specifics
of how it’s administered than it does to the relationship a patient has with their therapist.
If that therapist is over the internet, it might not make much of a difference.
Studies lend some support to the idea that getting cognitive behavioral therapy, or CBT,
online with a real clinician is effective. And experts say CBT is one of the best evidence-based
tools we have.
A 2014 meta-analysis found that guided online CBT — that is, with guidance from a therapist,
whether via email or real-time chat — produced similar effects to face-to-face therapy.
But for some patients, therapist guidance may not even be necessary.
A 2017 meta-analysis found that a self-guided form of online CBT may be a good first step
in treating symptoms of depression, especially for people who are unwilling to work with a therapist.
But not all online programs are created equal. There are far more apps out there than there
is research that’s been done on them.
A review in 2013 tallied more than 3,000 available mental health apps but found only 8 studies
and those involving only 5 of those 3,000 apps.
But even when there is research, it’s not exactly airtight. For one thing, most studies
have been designed to determine whether a treatment (or intervention, as it’s often
called) is practical, not necessarily effective.
Hardly any are placebo-controlled, and the few randomized trials out there tend to be
small and don’t end up being replicated. Plus, most of the studies are done by the
app developers themselves instead of independent researchers.
And that’s just studies in high-income countries. The research situation in low- and middle-income
countries is even worse.
And when a mental health app is bad, it can be really bad. Some contain information so
wrong that it’s harmful.
In a 2015 review of apps for bipolar disorder, researchers noted that one app recommended
taking a shot of liquor to help users sleep during a manic episode.
Another said that bipolar disorder can spread to your loved ones if they spend too much
time listening to your problems.
Just in case we have to specify: NO. BAD. NOT TRUE.
And of course, there are also the privacy concerns. Those are scary enough when you’re
downloading a game app to pass the time, but it’s way worse when you’re using an app
to share sensitive health information.
Researchers have voiced concerns about the fact that patient data from these apps might
be sold and used in algorithms that automatically classify people in ways that can affect their
credit, employment, and education.
But that’s not to say mental health apps are worthless. There are some success stories out there.
Take the app PTSD Coach, for instance.
It was developed through a partnership between the U.S. Department of Veterans Affairs and
the U.S. Department of Defense as a way to help military veterans with mild to moderate
symptoms of PTSD.
The app provides information about PTSD, helps users track their symptoms, supplies referrals
for crisis support, and offers CBT-based coping tools for times of distress.
A preliminary evaluation in 2014 and two randomized controlled trials in 2016 found the app to
be an acceptable intervention — though, as with many apps like it, the researchers
say they’ll need a larger trial to confirm its effectiveness.
But PTSD coach has another problem. It looks awful. Clinical psychologists aren’t graphic
designers, and they’re not exactly on the bleeding edge of user interface design.
That’s an issue with apps backed by research. Technology moves fast, and studies take time.
Once an evidence-based app is ready to hit the app store, it looks out of date next to
all the sleek, cutting-edge programs full of information that you can’t necessarily trust.
In general, experts note that online and app-based mental-health interventions have a lot of potential.
However, they’ve called for more research into the effectiveness and long-term effects
of these apps -- as well as ways to manage privacy and security concerns.
But as far as identifying which apps are worth downloading, there are some trustworthy resources out there.
The American Psychiatric Association has developed a model it uses to judge mental health apps
in four main areas: level of evidence, privacy and security, ease of use, and interoperability,
which is the ability to share the data with your healthcare team.
Other associations also review and rate mental health apps on their evidence. The Anxiety
and Depression Association of America lists 19 different apps on their website, for example.
Mental health apps aren’t perfect, but once they’ve been properly tested, they could
be a saving grace for people who don’t otherwise have access to the services they need.
More research and more vetting from trusted sources are still needed for them to reach
that point, though. One thing’s for sure: You can’t believe everything you read on
the app store.
Earlier in this episode, we talked about how privacy is a major concern when it comes to
mental health apps. But really, privacy is worth thinking about whenever you’re on
the Internet. And if you want to learn more about staying protected, you can check out Dashlane.
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