Technology and mental health
About 1 in 5 adults in the U.S. -- approximately 20% -- are affected by mental illness in a given year, according to the National Alliance on Mental Illness. Overall, 5% of adults in the country experience severe mental illness. Meanwhile, nearly every U.S. adult -- 97% -- owns a smartphone, according to the Pew Research Center. Many U.S. residents rely on their smartphones to count calories, make appointments, pay bills -- and for help with their mental health, via a wide array of apps.
"Technology today provides opportunities for mental health treatment that were historically impossible," says Cora B. Richter, associate clinical director for Rappore, a company that provides digital mental health services. She's based in New York City. "Using a digital rather than brick-and-mortar platform allows us to reach a much broader group of individuals, including those who live in geographic locations where quality mental health care is unavailable and those who don't have the accessibility needed to travel to a weekly appointment. Additionally, for many people who have busy, hectic lives, finding the time on a weekly basis to travel to a therapy appointment is at best inconvenient, and at worst unrealistic."
There are apps for a wide array of conditions, including:
Pros and cons
It's important to keep in mind there are a host of phone apps that are available, says David Fingerhut, director of mental health services for Everside Health, which has more than 300 clinics in 33 states and provides direct primary care for employer groups, including unions, municipalities and public school systems. Fingerhut is based in Indianapolis.
Mental health apps include simple chat bots with pre-loaded algorithmic responses, educational services designed to teach skills such as relaxation breathing or mindfulness exercises and apps that match consumers with trained mental health providers. "Given the enormous and growing mental health need and the relatively small supply of mental health providers in America, apps can play an important part in filling a gap in care," Fingerhut says. "However, it would be dangerous to view them as a total alternative to seeking professional medical help."
The advantages of phone apps are generally around their ease of use, the fact that they provide immediate access once downloaded, and that they are very private (in contrast to visiting a psychotherapist's office). "Such easy access may resonate with a segment of the population that would not ordinarily seek mental health services or engage with a mental health provider," he says. "In addition, many apps are either free or relatively inexpensive, which is why some users may be tempted to use them as a substitute for more expensive, conventional mental health services."
However, there are potential downsides. "While phone apps may be appropriate for mild, sub-clinical symptoms or clinical conditions such as stress, they are not an adequate substitute for a licensed mental health specialist when dealing with more serious mental health problems," Fingerhut says. "They are limited in their ability to provide customized treatments based on a patient's specific needs and challenges. It's important that a mental health professional be involved to ensure patients are properly interpreting the data from the app and acting on sound advice. This can only come from a specialist who has gotten to know the patient and fully understands the specific risk factors and what treatment approaches will work best for a given situation."
These serious mental health problems include:
-- Homicidal ideation.
-- Bipolar disorders.
Apps aren't a replacement for treatment with a health care professional.
The American Psychological Association doesn't have any official recommendations for using apps or texting systems for mental health care, says Vaile Wright, senior director for health care innovation at APA. "Apps based on evidence-based interventions may be helpful to manage stress or regulate emotions but are not a replacement to treatment with a licensed professional," she says. "Mental health apps may be more accessible to individuals and can provide adjunctive resources to those in ongoing therapy."
"However, because there are so many apps out there, it can be challenging for consumers to know which ones are effective at doing whatever it is they purport to do, and whether they securely protect your personal information and data."
Look for evidence of effectiveness.
A number of studies suggest that health care apps have been helpful for people dealing with various issues, according to a review of research published in May 2021 by the Agency for Healthcare Research and Quality.
"Several systematic reviews have identified positive effects of mental health apps on smoking behavior, self-reported depressive symptoms, and anxiety scores," researchers wrote. While some mental health apps have been studied and shown to be effective, there are many that have not yet been vetted through scientific methods, notes Loren Martin, chief science officer at Alter Health Group and a professor of clinical psychology at Azusa Pacific University in Azusa, California. "If exploring apps with unknown effectiveness, one should look for apps that are grounded in science in their approach to providing psychological care," Martin says.
Because there are so many mental health apps available, it can be challenging for consumers to know which ones might be helpful, says Sherry Pagoto, director of the UConn Center for mHealth and Social Media in the Institute for Collaboration on Health, Interventions and Policy at the University of Connecticut. She's a licensed clinical psychologist and professor in the Department of Allied Health Sciences.
If you're considering using a mental health app, look at the credentials of the people you will be interfacing with on the app, to verify their expertise and limitations. "I would also look for whether there is any published research on the outcomes of this app," Pagoto says. "If there is no research showing the app works I would adjust my expectations accordingly." She also encourages people who are experiencing a mental health crisis -- such as feeling suicidal or experiencing depression to the point they can't get out of bed and conduct their daily activities -- to speak to their primary care doctor about seeking clinical care before using apps.
Also, keep in mind that some mental health apps are free, and you need a paid subscription for others; prices vary. Some subscriptions cost more than one hundred dollars a month.
Look for specific types of apps and ask around.
Look for apps that mention mention common therapeutic approaches, such as cognitive behavioral therapy, Pagoto advises.
Try a few free apps for a couple of days to see which ones seem useful. Word of mouth can also be helpful. "I like the idea of asking friends for apps they might recommend," she says. "I particularly like apps that allow you to track things like mood, anxiety and/or daily activities, and apps that include stress reduction exercises, and/or provide a place to journal. These can be handy tools to deal with depression, anxiety and stress-related issues."
Keep in mind there is a raft of research showing the benefits of exercise on depression and anxiety. "Exercise apps may be very helpful for dealing with mental health symptoms," she says. "I will say that if a person is having trouble making it through the day, then I recommend they talk to a health care provider as opposed to turning to mobile apps"
Here are some apps that may be useful:
This app provides 24/7 access to mental health professionals, Martin says. The app is an online therapy service where you have a private, text-based chat room with a licensed therapist, according to an email response from Talkspace. As with some other apps, you start by answering a few questions, such as whether you've been in therapy before and how satisfying it was. You're typically matched with a licensed professional or coach, and stay with that person unless you choose otherwise.
The subscription service has a variety of plans, but you have to initiate the process to create an account and engage in the set-up process to see the pricing. Subscribers can cancel at any time.
This app also provides clients with immediate connections to behavioral health coaches, Martin says. Behavioral health coaches are available 24 hours a day, and it takes about a minute to connect to one, on average, according to the Ginger website. "Trained coaches provide encouragement and access to resources to help manage anxieties and reduce stress," Martin says. This is also a subscription service.
Developed by the Department of Veterans Affairs in partnership with the Defense Department's National Center for Telehealth and Technology, PTSD Coach was released in 2011. PTSD Coach is free and publicly available to help people with post-traumatic stress disorder. About six people out of 100 will experience PTSD at some point in their lives, according to the VA.
The app offers:
-- Information on PTSD treatments.
-- A symptom tracker.
-- Tools to use during stressful situations.
-- Links for support and help.
PTSD Coach is one of the most downloaded mental health apps developed by the VA, according to a VA spokesman. Since its launch, PTSD Coach has been downloaded more than 830,000 times.
The app received a major update in 2019 and has been enhanced multiple times since its release. It can be personalized with inspirational photos, songs and quotes and is available in English and Spanish. You can download it for free on the Apple Store and Google Play.
Other free VA apps
In addition to PTSD Coach, the VA's National Center for PTSD has developed an array of free, accessible and private apps that support mental health.
-- AIMS, for managing anger and irritability.
-- Beyond MST, which supports survivors of military sexual trauma.
-- COVID Coach, for managing stress and anxiety related to the COVID-19 pandemic.
-- Couples Coach, a dyadic app to support couples where one partner has PTSD.
-- Insomnia Coach, for managing symptoms of insomnia.
-- Mindfulness Coach, for supporting the practice of mindfulness.
-- PTSD Family Coach, for supporting the family members and loved ones of veterans who have PTSD.
-- Vetchange, for tracking and managing problematic use of alcohol.
To recap, here are factors you should think about when considering a mental health app:
-- Apps aren't a replacement for treatment with a health care professional.
-- Look for evidence of effectiveness.
-- Consider credentials.
-- Look for specific types of apps.
-- Ask around.
And here are apps that may be useful:
-- PTSD Coach.
-- Other free VA apps.