iCBT is a streamlined tool for logging emotional events, appraising them, and assessing their outcomes. The app is designed to be used in conjunction with a larger cognitive behavioral therapy (CBT) program, and provides no description of CBT to users. The app makes extensive use of a graphical user interface, and has users log emotions using slider bars.
Users begin engaging the app by logging an event. The app prompts the user to describe what happened, to select their feelings from a list of options (e.g. bitter, hopeless), to rate the intensity of their feelings using sliders, and to describe their negative thoughts. After doing so, users are asked to reappraise the event previously entered by identifying potential distortions (e.g. fortune telling, leaping to conclusions) which may have impacted the perception of the initial event (shown in a list), and then by typing their reappraised thought. At this point in the workflow, users are encouraged to ask themselves a series of challenge questions (e.g. “Am I positive this will happen?”), which were adapted from Sank and Shaffer (Sank, Lawrence I., and Carolyn S. Shaffer. A therapist’s manual for cognitive behavior therapy in groups. Springer Science & Business Media, 1984). After doing so, users are asked to log the intensity of their feelings using slider bars and to record the actual outcome of the event. In the outcomes logging section, slider bars are only shown for the emotions initially identified. Upon completion, users are offered the opportunity to save their event, delete it, or email it to someone.
Ease of Use and User Experience
The app is easy to use and contains instructions which will assist anyone who does not find it intuitive. While the app has a great user experience, the reasons for its use may be unclear to a person without prior experience with CBT. Nonetheless, the app would be very appropriate for a clinician to recommend to a patient to use between sessions.
The app’s layout is well-designed. The app was tested on an iPhone 5S and an iPhone 6S, and rescaled appropriately to fit the dimensions of the screens of both devices. Users are guided through the process of logging their events, appraising them, and then assessing their outcomes in a linear manner. Slider bars are used to log the intensity of emotions. After users input the intensity of their re-appraised emotions, they are provided the option to overlay their current emotional intensities with those previously inputted. The app developers have thus creatively used the slider bars as both an input method and as a means to display improvement. Literacy is required in order to successfully use the app.
Appropriateness of Content
The app’s content is appropriate for an individual already working to incorporate CBT techniques into their life. It may not be appropriate for a person new to the concepts or not working with a clinician.
Appropriateness of Feedback
The app does not provide the user with feedback, but instead forces the user to evaluate events in a systematic fashion.
The app’s cognitive challenge is derived from the questions posed to the user during the event logging process. The app contains a list of “challenge questions” which can be used to reassess thoughts. These questions are dispute handles such as “Are there other possible explanations?” and “Does everyone share this person’s opinion?”.
Ease of Account Management
The app contains optional password protection. This feature is somewhat hidden, and can only be enabled by selecting an option that appears at the top of the “Help” document. Passwords can be changed if desired. While the developers can be contacted to reset the password in the event that it is lost, there is no way for a user to remove all use of passwords once one has been created.
The app cites Sank and Shaffer’s book on CBT as the source of the challenge questions contained within the app. The overall workflow of the app is consistent with the mental workflow recommended by CBT. One slight difference between traditional CBT and what occurs within the app is that the app focuses on re-evaluating events rather than behaviors. The author, Bonfire Development Advisors, is a company which specializes in creating mobile and web applications, rather than in mental health.
Qualitative Review of Program Efficacy
iCBT is quick and easy to use, and captures data in a well-structured way. It is likely to be an effective tool if used in conjunction with CBT training. The workflow within the app matches the workflow of that therapists and other CBT programs often recommend patients conduct on their own as homework.
Estimate of Efficacy Relative to Similar Products
A number of CBT tools offer logging as a component of a larger depression training and management program. The streamlined and comprehensive nature of iCBT makes it a superior offering to many of the logging tools built into other app and web-based programs.
$5.99 as of December 2015