As availability of and interest in digital health increases, anecdotally we hear of more and more clients asking their therapist about apps for mental health. As a professional, it can be challenging to keep up with the breakneck pace of technology development in this area (along with everything else you have to do on a daily basis). Luckily, there are lots of resources for professionals who are interested in integrating apps into their practice. The Department of Defense Mobile Health Practice Guide, for example, is a comprehensive resource which can be used by professionals across the care spectrum, and gives a number of practical tips for the introduction of apps to clients. Dr. Joe Ruzek wrote a great piece for the PsyberGuide blog on bringing apps into the treatment process which we strongly recommend professionals to read. Dr. Ruzek outlines some key strategies and practical tips for introducing apps to clients and integrating technology into your sessions.
Of course, before you even reach the stage of introducing an app, you need to choose the right one. With so many available, and few that have been researched or vetted in any way, this part can be a challenge. Efforts to help professionals make this choice can be broadly divided into two categories: app rating frameworks, which can be used by those considering apps (e.g. the American Psychiatric Association’s App Evaluation Model), and app rating platforms, which function as clearinghouses for apps (e.g. PsyberGuide, ORCHA, MindTools). Debates in the digital mental health space often center on the relative value of frameworks versus clearinghouses. At PsyberGuide, we don’t see this as an “either/or” decision, but rather we consider a model where both approaches can complement each other and be used at different stages of the decision-making process, so that professionals can most informed choice possible. When choosing an app to use with your clients, we see two key stages in making this choice, which are outlined here.
Stage 1: Use a clearinghouse to identify some contenders
The first stage is to explore the app marketplace and identify which apps are relevant and potentially beneficial to your clients. This is where app clearinghouses such as PsyberGuide can be really useful. You can use our App Guide to find apps based on a combination of target conditions and/or treatment types (e.g. CBT, Mindfulness, Stress & Anxiety). You can also filter based on audience (e.g. adolescents, military personnel, or LGBTQ+), platform (Android or iPhone), and cost.
We review apps on three metrics: credibility, transparency, and user experience. No app will work for everyone and no score alone will determine which app is the best fit. For example, if you are working with a client who has expressed skepticism about the security of technologies for health, they may be reassured by a strong transparency score. If a client is less tech-savvy, they may need an app with an easy and engaging user experience. The credibility score is a good place to start, to ensure you’re recommending apps which are grounded in research and developed by a credible source.
Stage 2: Use a framework to determine relevance & appropriateness
When you’ve used a clearinghouse such as PsyberGuide to identify which apps are “contenders”, take a deeper dive into each of the apps to determine if they are appropriate for your setting, client, and care plan. You can and should download the apps you’re considering and explore their full functionality. At this stage, the American Psychiatric Association’s App Evaluation Framework is a helpful tool to guide you. This framework will guide you through relevant information that should be considered when picking an app, in the areas of Safety/Privacy, Evidence (i.e., effectiveness), Ease of Use and Interoperability. These four areas are presented in a hierarchy, such that if one is unsatisfactory, it’s not necessary to consider the others, and therefore the app should probably not be used.
Crucially, at this stage of “getting to know” the apps, you should consider how various cultural considerations can impact uptake and use of digital health tools. Just as you tailor your treatment plans around the individual, cultural, and systemic factors with which each client presents, consider how the apps address factors like ethnicity/race, language, gender identity, sexual orientation, age, socioeconomic status, etc. Use your professional judgement to determine if the app is an appropriate cultural fit for the client.
We understand that the app marketplace can be overwhelming, and that’s why so many organizations and researchers are motivated to help you make informed choices. At the end of the day, we’re all working towards the same goal: to help people use credible, effective, accessible technologies to improve and manage their mental health.