Bringing apps into the therapy room

Dr. Schueller is the Executive Director of PsyberGuide and an Assistant Professor at Northwestern University’s Feinberg School of Medicine. He is a faculty member of Northwestern’s Center for Behavioral Intervention Technologies (CBITs) and his work focuses on increasing the accessibility and availability of mental health resources through technology.

Many people get excited about the potential of mobile apps to transform mental health care because not enough current treatment resources exist. Long waiting lists, limited availability in rural areas contribute to difficulties in receiving care. Therefore, a lot of apps, app-based services, and app research studies are intended to be used instead of traditional face-to-face services. However, this overlooks the fact that for many people, having a professional relationship with a licensed mental health provider might be necessary to deal with their mental health issues. Furthermore, licensed providers might be able to guide people to effective apps and help them steer clear of bad ones. Thus, mobile apps can play a role in the context of face-to-face practices. As adjuncts to traditional care they can increase people’s engagement with their treatment and hopefully make such treatments more effective and efficient.

Providers then need guidance as to what apps are effective, what features they offer, and how they might be able to be used in their practice. A recent review of mobile apps for mental health attempted to address some of these issues with questions such as what are the common features of apps that are effective? And what are the implications of such findings for practitioners? Joyce Lui, David Marcus, and Christopher Barry from Washington State University combed the research literature and identified 21 studies evaluating 18 different apps.1 These apps targeted anxiety disorders, mood disorders, post traumatic stress disorder, schizophrenia, and substance use disorders. Eight of those apps, or roughly half, were designed specifically as adjuncts to traditional therapy, including things such as DBT Coach for or The Stress Manager. We’ve identified several other apps on PsyberGuide that are intended for use with providers like the eCBT of the VA’s PE Coach.

Most apps have some form of symptom monitoring and a menu of therapeutic skills. Common skills included cognitive restructuring, relaxation techniques, drink refusal skills, and scheduling pleasurable activities. If you are a provider and these are skills you cover in your practice then there are several apps that can help support your clients practice these skills outside of sessions. If you are a client receiving therapy, apps that help monitor symptoms might provide you the tools necessary to bring objective data into the therapy room when you’re asked “So, how was your week?”

Very few apps offer testimonials from individuals who have recovered from the same disorder or used that app. This is unfortunate because learning how other people used the same app to overcome similar difficulties could be useful for both clients and providers in determining how that app might be useful for them. Social features within the apps often use people’s own contacts within the phone or can share progress on social media. I would strongly encourage clients and providers to be wary of the use of social media within mental health apps. Few apps provide details about how user’s information is gathered or returned to the software developers. Information may be shared to a user’s social media account inadvertently, without the user’s knowledge, or a user may later come to regret information that was shared intentionally. It would be great if more apps had safe and secure ways of connecting users to other people, but currently this does not seem to exist in most mental health apps.

In the end, it appears as though apps that could be brought into the therapy room face many of the same issues that mental health apps do generally. Too many apps with too little research evidence makes it hard to separate the good from the bad. Therefore, I would really encourage clients and providers to consult guides, like PsyberGuide, to engage with their professional communities (e.g., local and national organizations), and if you are using apps in your practice to share what you’re learning. We’re always happy to hear from people at PsyberGuide and will be working to develop more resources to help providers interested in using apps in their practice.

  1. Lui, J. H., Marcus, D. K., & Barry, C. T. (2017). Evidence-based apps? A review of mental health mobile applications in a psychotherapy context. Professional Psychology: Research and Practice48(3), 199-210. http://psycnet.apa.org/psycinfo/2017-07848-001/

 

 

 

 

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