Do mental health apps work? NJ therapists review BetterHelp, Calm and other options

With a rating of 4.9 out of 5 stars in Apple’s App Store, Wysa, an AI chatbot that guides users through therapy and journaling, might seem like a good choice for anyone feeling depressed or anxious. Another app, Calm, focuses on guided meditation and sleep improvement to promote stress reduction; it boasts over 150 million downloads.

From self-help mood trackers to programs that arrange remote counseling sessions, mental health apps abound online even as counselors are in increasingly short supply, amid what many professionals say is a growing mental health crisis.

So do mobile apps provide a good alternative? Here's a look at some of the popular programs and what therapists think of them.

The Apps

A variety of options are available to online clients. Examples include mood-tracking programs like Daylio, which helps users log their emotions. Mindfulness apps such as Headspace focus on meditation and stress reduction. Woebot Health uses AI to mimic therapy. TalkLife and 7 Cups advertise community support. Others like BetterHelp and Talkspace connect users with professional therapists.

Prices vary widely. Apple devices offer free mental-health apps with basic services. A BetterHelp subscription costs $65 to $90 per week for access to its counselors, and an annual Calm membership runs about $70. Woebot is free, but it can be accessed only with a code given by a mental provider or agency partnered with the company.

The Crisis

So how do apps stack up to a human counselor?

First off, they're available 24-7, a boon in a mental health profession beset by labor shortages.

"The need continues to increase for mental health services while the workforce is declining,” said Debra Wentz, president of the New Jersey Association of Mental Health and Addiction Agencies, who called the new crop of mental health programs "valuable."

Poor reimbursement rates, low retention due to stigma, increased demand and an aging workforce are some of the reasons therapists have been leaving the field since the COVID-19 pandemic.

At the same time, 52% of psychologists said they are seeing an increase in the severity of symptoms among patients, according to a recent survey by the American Psychological Association. Among its members, 41% noted an increase in the number of sessions spent treating each patient, reducing their capacity to accept new clients.

Sarabjit Singh, director of behavioral health services for Prime Healthcare hospitals in Morris, Passaic and Essex counties, said professionals leaving the field over the last six months have made the search for solutions even more urgent.

Supplement for in-person care

There’s no doubt that apps will play an increasing role in access to care. But researchers advise caution. Studies, including those from Harvard Health and the peer-reviewed journal mHealth, have found limited efficacy for mental health apps. While they offer benefits like symptom tracking and convenience, they should supplement, rather than replace, traditional therapy, experts say.

“For someone with serious mental illness or a serious issue with substance abuse, you want somebody who is a licensed, experienced practitioner,” Wentz said.

This distinction is crucial, she added, because the landscape is flooded with apps that vary widely in quality.

"It certainly has changed the entire environment and way of thinking," she said. The shift to technological counseling is taking place amid increased isolation among Americans due to changing work environments, Wentz noted.

Apps may be good at reminding people to do things that will improve their moods, like tracking feelings or getting more sleep. But Wentz is skeptical about whether they will work when bigger problems arise.

Singh agreed. Mental health apps cannot replace therapists. Human connection is too important, he said.

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BetterHelp, which did not respond to requests for comment, says it has an arsenal of 30,000 licensed counselors at the ready. Although Singh isn’t sure if such apps are bringing new therapists into the system, they may at least be helpful when it comes to connecting supply and demand.

“I think if done the right way, it will only help," he said. "Most of the mental health professionals are actually towards the West Coast and the East Coast. But there are so many people suffering right in the middle, and there are no resources for them.”

Tracking mental-health symptoms in real time

Singh, who teaches residents and is guiding the next generation of mental health professionals, also sees promise in the apps' ability to address one of therapy’s classic weaknesses: unreliable self-reporting.

Recall bias — the inability to remember clearly how one felt in the past — can thwart therapeutic attempts. Problems can be hard to sift through when thoughts like “I feel better today, so yesterday must not have been that bad” get in the way. Apps can track symptoms and behaviors in real time and offer a more accurate understanding of someone’s health.

“Apps can improve self-reporting, which is beneficial in clinical practice,” Singh said. “Without technology, patient reports can be biased by their current mood.”

The programs can also help with goal-setting and tracking progress and can teach people about psychology along the way, Singh added. He’s looking forward to seeing how more use of artificial intelligence will enhance online tools' effectiveness. It already makes them more responsive than apps like Mindfulness and Health, the trackers native to Apple watches, phone and iPads, which allow users to log basic responses about their moods.

Researchers find 'medium level of effectiveness'

New findings published in the Journal of the American Medical Association in November seem to justify Singh’s optimism. “App-Based Interventions for Moderate to Severe Depression” highlighted 13 studies that evaluated 16 apps used by almost 1,500 participants with moderate to severe depression.

Researchers found that the apps have a “medium level of effectiveness.” In other words, they were helpful, but not a cure-all. They provided easy access to support, but they were more effective for people with smaller problems who were not already in therapy.

The apps were useful for identifying and changing negative thoughts and behaviors and building coping skills. They were less effective, however, when it came to long-term problems like severe depression. 

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How to choose mental health apps

This is still an “evolving” field, Wentz said. Don’t view these apps as panaceas. She cautioned against premature conclusions about effectiveness. Still, experts offer these guidelines:

• Look for apps developed with input from mental health professionals and endorsed by impartial third parties, as opposed to user testimonials, advised the University of California at Berkeley's "Greater Good Magazine." Be careful about apps that start out with free trials but automatically shift to paid subscriptions, or those that require payment information upfront.

• When it comes to apps that offer virtual therapy sessions, make sure counselors are licensed to practice in their field, Wentz said. An online search is the easiest way to do this, said the OpenCounseling blog. Additionally, licensing board websites typically feature a search page.

• Seek professional help for serious concerns such as self-harm. Apps should not be seen as replacements for professional care if your mood is volatile or if you're seeing significant impairment in your relationships, Singh said, adding that such problems may indicate a need for professional, in-person counseling.

• Mental health apps, he added, "should just be limited to adults for now, because kids — from a normal developmental perspective — their emotions could be all over the place, or they can misinterpret what the app is saying ... On one hand, you want to encourage students to be able to do it, because that's their way of reaching out. But teenage issues are very difficult.”

Gene Myers covers disability and mental health for NorthJersey.com and the USA TODAY Network. For unlimited access to the most important news from your local community, please subscribe or activate your digital account today.

Email: myers@northjersey.com

Twitter: @myersgene

This article originally appeared on NorthJersey.com: Do mental health apps really work? NJ therapists weigh in