Should your smartphone be your therapist? Thousands of mobile apps claim to help people improve their mental health. Some offer relationship advice and productivity tips; others aim to make psychiatric disorders easier to manage. Yet the vast majority of them have no solid scientific basis, as a recent study concluded. Last year the U.S. Food and Drug Administration announced that it would begin regulating medical apps that claim to diagnose various conditions, such as heart disease and sleep apnea. Psychiatric apps that serve to identify symptoms, rather than diagnose disease, may be exempt from oversight because the agency believes they pose a lower risk to the public.
Some experts, however, feel that psychiatric apps deserve the same scrutiny as medical devices and have raised concerns over their safety and effectiveness [see “Apps to Avoid,” below]. Only more rigorous studies can ensure that these programs offer a real benefit, determine how they might complement other forms of therapy and help people make more informed decisions about which ones to use. Here Scientific American Mind takes a critical look at a range of popular mental health apps.
DEPRESSION AND ANXIETY
For iPhone/iPad (free)
Optimism is a mood-tracking app for people with depression and bipolar disorder, as well as those simply looking to brighten their days. Users regularly record their emotional state, along with other factors, including the amount of caffeine or alcohol they have consumed each day and the quantity and quality of their sleep and exercise. The app charts these variables in a line graph, helping people visualize how various factors may interact to influence their mood. The app also allows users to record potential “triggers,” or occurrences that negatively affect their mental health. By constantly keeping tabs on their mood and environment, users may learn to recognize key triggers and head off bouts of depression or anxiety before they occur. Although published data are lacking, psychologists at George Washington University are assessing the app's effectiveness in an ongoing study.
For iPhone/iPad and Android (free)
PTSD Coach was developed by the U.S. Department of Veterans Affairs with service members in mind, but it can be used by anyone dealing with trauma and anxiety. It is designed to supplement regular therapy for individuals coping with trauma and to help users track their symptoms. The app offers advice and coping strategies, such as relaxation techniques. When users indicate that they are in crisis, the app helps them find immediate support by directing them to the phone numbers of loved ones, as well as nearby treatment programs and hotlines.
For Android (free but currently unavailable)
This app from researchers at Northwestern University takes full advantage of users' smartphones to sense when they are depressed. It uses a phone's built-in accelerometer and GPS to collect data on a person's location and movement, and its algorithms monitor how often a user talks on the phone, texts and interacts with social media. When the app detects a pattern of isolation, it sends a text message or automated phone call urging the user to get out and do something fun. In a small pilot study, eight people with depressive disorders revealed significant improvements in their symptoms via self-reports and telephone interviews with the researchers. Yet the app had trouble accurately predicting users' moods, and the study itself was flawed because it failed to include a control group.
The team at Northwestern recently pulled the app off the market to refine its features. The researchers are currently recruiting volunteers for a larger trial on depression. The app will be rereleased in 2015, and those interested in testing the app can sign up at the developers' Web site at http://cbits.northwestern.edu/#!/page_participate
For iPhone/iPad ($4.99)
SuperBetter helps you work toward specific goals—such as reducing anxiety, losing weight or fighting depression—by allowing you to create your own superhero identity and adventure. The idea is that “gamifying” your goals may make it easier to achieve them and to stay motivated. To work toward a desired objective, you can develop your own adventure or choose from “Power Packs” of predefined quests, bad guys (that is, people or triggers that may trip you up along the way) and other activities developed with input from researchers at Stanford University, the University of California, Berkeley, and elsewhere.
In the “Lazy Exercise” Power Pack, for example, an activity could be dancing to your favorite song, and bad guys might include sitting for more than an hour at a time and driving when you could walk. You can also recruit “Allies”—friends from Facebook or other SuperBetter users—to play with you. In a small, unpublished randomized controlled trial in collaboration with the University of Pennsylvania, 19 people with self-reported depression improved by 17 points on a standardized depression test after six weeks of playing SuperBetter compared with about six points for those who did not play the game.
For iPhone/iPad ($1.99 each)
Married clinical psychologists John and Julie Schwartz Gottman developed 11 apps based on their own relationship research (John Gottman is also an emeritus psychology professor at the University of Washington) and have experience in counseling couples in family therapy. One, called Love Maps, is a relationship app designed to foster open communication between long-term partners. Another, called Open-Ended Questions, suggests conversation starters that couples can use to escape the monotony of everyday topics such as “What's for dinner?” Other apps help couples express their relationship needs in a positive, nonjudgmental light. Research shows that open communication, even about day-to-day minutiae, is associated with greater relationship satisfaction and lower divorce rates in couples who attend counseling. Though heavy on science, the apps' simple design may turn off more tech-savvy users. Text in the apps is displayed in a basic font on plain, Microsoft Paint–style backgrounds, and the software has limited functionality. One customer review notes that the app is basically “index cards with questions.”
For iPhone/iPad and Android ($95.88/year for full content)
Headspace is a popular guided-meditation app that helps users achieve mindfulness, or a nonjudgmental, focused awareness of one's current emotional state. After a couple of minutes of breathing exercises, the app prompts users to pay attention to the sounds around them and to do a mental scan of their body for any aches and pains. Each session lasts 10 minutes and is led by app developer Andy Puddicombe, a former Buddhist monk. The theory behind mindfulness is that when practitioners notice these details, they become more in tune with their moods and can more easily identify and control their emotions in any situation. In fact, research shows that practicing mindfulness can relieve stress, reduce anger and help people overcome addiction.
For iPhone/iPad (free)
Like Candy Crush but better: Lumosity offers fun games aimed at building users' brainpower. Players can choose from more than 40 games focusing on different skills, including attention, memory, processing speed and problem solving. Pilot studies led by Stanford University researchers indicated that Lumosity enhanced memory, multitasking ability and processing speed in children and adults with cancer-related brain injuries.
Yet when several independent research groups tried to replicate these promising results in healthy individuals, they failed. Although participants in these latter studies became more proficient in performing the in-game tasks over time, the improvements did not enhance cognitive ability in real life. Lumosity may provide some short-term benefits, but do not expect monumental transformations.
For iPhone/iPad, Android and Windows (free)
The 28 games included in this app are aimed at people who want to sharpen their wits while juggling a busy schedule. Each game targets a specific skill set and takes only two to three minutes to play. Some games involve memory and concentration; others are more traditionally academic, such as those for building vocabulary or freshening up math skills. In a game aptly entitled Face Memory, users are challenged to improve their facial recall so they will never again find themselves awkwardly asking an acquaintance, “What's your name again?” Although the app has not been tested in a controlled study, Mind Games is based on psychology research that demonstrates that people who alternate between different cognitive exercises learn more efficiently.
For iPhone/iPad (free)
People prone to distraction may benefit from 30/30, a time management app that helps users focus on the task at hand. The app first prompts users to set up to-do lists for the day and estimate how long each item will take to complete. When users are ready to start tackling the list, they can tap on a countdown timer, kicking off a 30-minute work session during which they have committed to focusing on one task at a time without interruption—absolutely no e-mail, Facebook, Twitter, Big Bang Theory recaps or any other microdistractions. When the time is up, users get a 30-minute break (or less) before the cycle starts again. (Users, however, are not obligated to work in 30-minute chunks; they can set any length of time to complete a task.) 30/30 is based on research indicating that separating work into smaller chunks makes it more manageable, with frequent breaks serving as rewards for staying on track.
For iPhone/iPad and Android (free)
MediSafe is a “virtual pillbox” that can help keep track of complex medication schedules. The app reminds users when to take each medication and prompts them to scan the bar code on the prescription label once they have done so. If a person forgets or misses a pill, MediSafe sends a notification to a designated friend or relative, who can check in on the patient. Data accumulated over eight weeks in 2012 indicated that 81 percent of MediSafe users were taking their medication on time. By comparison, World Health Organization data suggest that the average rate of medication adherence is 50 percent. MediSafe also sends users reminders to refill their prescriptions when they are getting low.
APPS TO AVOID
Watch out! Some apps make big claims with little evidence
According to the FDA, those psychiatric apps that provide coping techniques for people with diagnosed mental health conditions pose low risks to consumers. These apps will be regulated at the fda's discretion, and many will therefore escape the agency's safety and effectiveness assessments. Some experts, however, say that these apps can still be hazardous if they give out shoddy advice or otherwise mislead vulnerable consumers. “Some of [these apps] are really good, and some of them are awful,” says Michael Van Ameringen, a psychiatry professor at McMaster University in Ontario. “Clinicians and consumers need help sorting through them.”
For instance, be wary of apps designed by software companies that fail to include insight from a medical professional (such as many of the hypnosis apps out there), as well as apps claiming to use audio tones to induce certain mental states, such as decreased anxiety (there is no scientific validity to these claims).
The Anxiety and Depression Association of America, of which Van Ameringen is a board member, is currently developing a rating system to screen out bad apps. Here are some things to keep in mind when browsing mental health apps:
If you are in immediate distress, see a doctor. Apps cannot replace diagnosis and treatment; they are supplements only.
Check out the science. Many apps claim to have experimental support, but often those studies are performed by teams of in-house researchers and lack scientific rigor. Studies conducted by independent researchers and published in peer-reviewed journals provide a more objective assessment.
Take design into account, too. You are more likely to use the app regularly if the experience is easy and enjoyable. It also helps if the app can be customized to your unique needs, Van Ameringen says.