This week, we are very fortunate to have David Bakker  as a guest blogger. David is in his final year of a Doctor of Clinical Psychology at Monash University where his research is in the field of mental health apps. He shares his expertise with us here….

 

Smartphone apps have revolutionised many services, from ordering food, summoning a taxi, or making and tracking fitness goals. Some apps are now aiming to support users’ mental health and wellbeing, and while some show promise, it is a young field that is largely untested.

As a therapist, I wanted to find reliable apps that I could recommend to or use with clients. To start searching, I conducted a review of the available mental health apps and the academic literature surrounding them. My colleagues and I noted many ways that existing mental health apps could be improved, and we also noted that lots of apps fell into two broad categories.

The first are apps that have been designed by psychologists or researchers, which often use evidence-based mental health strategies but may execute them in a clumsy or suboptimal way. These apps usually need to be introduced to the user by a health professional and are not well suited to how people use smartphone apps.

As is the case with many professionals, psychologists have a tendency to think about problems using their own established frame of reference. For example, since the days of Freud the standard therapy session has been set to be 50 minutes long. Innovative practitioners have recently started using 90 minute sessions, which are better suited to modern cognitive behavioural therapies, but changing the length of a standard session is still a very alien concept to most psychologists.

People don’t use their smartphones for 50 minutes at a time, so psychological practices have to be adapted to the short, discrete, simple interactions used by apps.

The second kind of apps that we reviewed are ones primarily developed by professional app developers. These may be slicker and use more interactions appropriate for smartphones, but lack mental health strategies that are based in evidence or have been designed by mental health professionals. These apps can have a lot of commercial appeal and are attractive to smartphone users, but there is no way of knowing if they are actually effective and if they deliver on their promises.

So how do you find apps that straddle these two categories? How can you find ones that use both good app design and psychologically rigorous approaches?

  1. Check to see if it uses evidence-based techniques

Apps will usually announce if they are using evidence-based therapies or approaches. For example, cognitive behavioural therapy (CBT) is the approach with the most evidence for anxiety and depression, so choosing a CBT-based app can be a good way of ensuring this.

  1. Check whether you can use it broadly and across a variety of situations

If you had an email app that could only send images, it would be extremely frustrating and limiting to use. In fact, you may end up just deleting it. In the same way, if a mental health app only has one tool, it can be restrictive for the user. Apps that can be used across a variety of situations and feelings, e.g. both anxiousness and low moods, can confer more benefits.

  1. Check to see if the app gives you actual activities or strategies to try out

The biggest gains in therapy are made when clients actively do things. They engage in strategies and try out activities that can help them find new, more helpful ways of dealing with problems. If an app is too passive and doesn’t arm its users with things they can go out and do, it misses the opportunity of real-world engagement. A huge advantage of smartphones is that they can be carried into any situation, so apps excel when they engage users actively.

  1. Check for experimental evidence supporting the app

One of the biggest shortcoming of the current range of mental health apps is the lack of experimental evidence. Most therapies need experiments like randomised controlled trials (RCTs) to support their efficacy before being recommended. However, only a handful of RCTs have been conducted for mental health apps, and most of the apps tested are no longer available on the app stores. In fact, at the time of writing there are no anxiety and depression apps available that have RCT evidence. Apps with experimental evidence usually proudly display it on their websites, so if you can’t find any just proceed with caution.

These four considerations have been condensed from the full list of sixteen presented in the original research article.

Reviewing the available apps and their features was the origin of MoodMission, an app that aims to deliver effective, evidence-based mental health strategies in a way optimised for smartphones. After a successful crowdfunding campaign and 9 months of building and testing, MoodMission’s first version is now available on the iTunes Store. The app is available for free for iPhone currently, and following a second crowdfunding campaign we are now developing it for Android.

MoodMission is for everyone. We all experience low moods or anxious feelings from time to time, and it’s often how we deal with these feelings when they arise that can be the difference between waking up tomorrow afresh or spiralling into a pattern of mental illness.

moodmission

 

When you’re feeling down or anxious, you go to MoodMission and say how you’re feeling.

MoodMission then picks 5 evidence-based mental health strategies out of a big database of over 200. These 5 “Missions” have been tailored to you based on how you’re feeling, and are all short, easily achievable, well-defined activities. After you’ve done your Mission you again rate how you feel, and MoodMission uses this to learn what sorts of strategies work for you and tailor itself to you over time.

While most other mental health apps are like single tools or small toolsets, MoodMission is like a giant toolbox with an expert advisor offering you the right ones. In this way it’s kind of like a therapist-in-your-pocket who is full of good suggestions on how to cope effectively.

Below is a table of some good quality apps that adhere to evidence-based guidelines.

 

 

Recommendations
App Purpose/issues addressed Evidence-based techniques Broad use with many tools for specific problems Supplies activities & strategies Experimental evidence from RCT
MoodMission Strategies for dealing with low moods and anxiety

RCT underway
Smiling Mind Mindfulness meditation

Research in schools underway
Pacifica Anxiety and stress

RCT underway
MoodKit Suite of CBT tools

RCT underway
BeyondNow Suicide prevention planning

RCT underway
MoodPrism Mood tracking

RCT underway

1 in 3 people will experience clinically significant anxiety or depression. The other 2 in 3 will experience anxious feelings or low moods that have potential to develop into a clinical disorder. If people are equipped with a large repertoire of effective coping strategies, resilience is boosted and the likelihood of clinical problems falls.

65% of people who experience a mental health issue do not receive treatment. MoodMission and other digital mental health tools aim to overcome barriers of stigma, isolation, and accessibility issues, and bring effective treatments and preventative measures to everyone with access to technology. Hopefully this can make a difference to the mental health and well-being of all.


Monash University is currently researching mental health and wellbeing apps and is looking for participants for a randomised controlled trial. You don’t need to be experiencing a mental health issue to participate, but you will need to be over 13 years old and own an iPhone. Please click HERE if you would like to participate.