Mobile mental health
The use of cell phones for purposes beyond making basic phone calls is nearly ubiquitous. According to a 2013 report released by the Pew Research Internet Project, of the 91 percent of Americans who own cell phones, approximately 60 percent use their cell phone to access the internet, and about one-half of users download apps.
Apps designed to support a user’s health and wellness, including mental and behavioral health apps, have become especially popular. For example, iPhone now automatically includes a health app with its latest operating system, IOS 8. Non-psychologist users of these apps may find them appealing because the apps often provide behavioral health-related tips or even allow users to assess symptoms of concern, such as stress and anxiety.
From a professional perspective, many psychologists may wonder how such apps might benefit practice.
Because the general use of apps as an adjunct to traditional psychotherapy is in its infancy, very little research has been conducted on its benefits. However, the United States Department of Defense’s (DOD) National Center for Telehealth and Technology (“T2”) is making a concerted effort to get this technology into the hands of its clinicians to supplement therapy with deployed and veteran soldiers. T2 is in the early stages of evaluating the use of apps in this context.
One popular app released by the DOD is “PE Coach,” which is designed to make prolonged exposure (PE) therapy easier to implement. The features of this app allow the patient to audio-record treatment sessions and to record completed homework exercises, among other things.
The therapist also benefits from the patient’s use of this app by being able to track homework completion rates along with the patient’s symptom severity over time. Further, the app may eliminate administrative burdens otherwise facing the psychologist, such as graphing a patient’s symptoms.
Additionally, some clinicians who use PE therapy indicate that their patients often scramble to complete in vivo homework in the waiting room immediately before their session rather than as a part of daily life, as intended. The app potentially makes adherence to the fidelity of this therapy more likely by prompting individuals to complete homework between sessions.
While current studies are under way in determining whether there are benefits to using apps as an adjunct to therapy, researchers are also interested in determining how the use of apps affects — or is useful for — various treatment paradigms.
Budding research is attempting to identify challenges and benefits that might come from using behavioral health apps. For example, some research indicates that older patients may not be as comfortable as younger patients in using apps to manage their care or augment their psychotherapeutic treatment plan. Also, some clinicians find that training each patient to use apps correctly and consistently can prove to be a hurdle.
Based on early research, apps that augment cognitive-behavioral therapy (CBT) and those used to facilitate substance use treatment appear to have clinical utility — for example, by warning individuals to stay away from trigger sites for problem drinking. The usefulness of apps in supporting these therapeutic processes have been demonstrated through analogous apps that are being used in health care to monitor physiological factors for patients with chronic medical conditions — for example, blood sugar monitoring for those with diabetes.
Proponents of using behavioral health apps to supplement psychotherapy believe that facets of behavioral and mental health treatment related to CBT and substance abuse can also be applied through apps. For example:
- Having patients diagnosed with anxiety or depression complete symptoms ratings within an app.
- Including preprogrammed prompts for mood self-assessment throughout the day.
- Helping those with substance use issues identify and avoid triggers.
While apps offer the prospect of improving compliance with these essential therapeutic tasks, they are no replacement for certain exercises led by the therapist. More research is needed to ascertain behavioral health apps’ potential to augment therapy. While some controlled studies are under way (see the Clinical Trials website), psychologists ultimately need to experiment with and evaluate the implications of using this new technology as a regular part of professional practice.
For more information on mobile apps, including privacy and security, and types of apps to consider, check out the article “The New World of Apps” (PDF, 350KB) in the Winter 2015 issue of Good Practice magazine.