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Dr. Meredith Meacham is an Assistant Professor in the Department of Psychiatry at the University of California, San Francisco (UCSF). She studies how digital tools may be used for monitoring and improving substance use and mental health outcomes.

Reviewed on: July 24, 2019

Pros

  • Targets depressive and anxious moods
  • Lots of activity suggestions with accompanying explanations
  • Attractive design
  • Most content is free with some customizable content ($)
  • Password-protected

Cons

  • May not be as helpful for high distress or crisis moments
  • While it does address behavioral coping, there is less attention to cognitive aspects of Cognitive Behavioral Therapy
  • Few opportunities for setting or thought input beyond numeric scale and type of depressive or anxious mood that may facilitate deeper understanding of one’s mood
  • Several suggested activities may be impractical in certain settings or require advance planning
  • Some of the text explanations are small and may be hard to read for some users
  • Sign-in issues: may need to sign-in for each use of the app and inconsistent push notifications on iOS (but not Android)

Content:

3.75/5.00

Ease Of Use:

4.33/5.00

Visual Design:

4.66/5.00

Product Description

MoodMission is an app that is intended to help adults and older adolescents learn ways of coping with low moods and anxious feelings. It does this by suggesting “Missions” or activities, in response to a user responding to prompts about their low or anxious moods. The missions are thought-, physical-, behavioral-, or emotion-based, and many can be done right away, though some suggested missions would take more time and planning. Once users complete a Mission, they are prompted again to rate their mood and how helpful the activity was. This information is then recorded in the Mission Log, which can be reviewed at any time.

The app has a sleek design with mountain climbing imagery and warm colors. Upon downloading the app, a series of start screens describe the purpose of the app, when to use it, how it works, and how it adapts. The main page of the app is a link to “Other Support Options,” which includes phone numbers for helplines in Australia, Canada, New Zealand, and the United States, and a link to more information (mostly Australia-based) on the app’s webpage.

Setting up a profile takes 5-10 minutes; users register with an email address, enter some demographic information, and complete an assessment of depression (using the PHQ-9 questionnaire) and anxiety (using the GAD-7 questionnaire). There are four optional surveys that can also be taken as part of a research study by the app makers.

Following initial set-up, each subsequent app interactions only takes about a minute, in which time users respond to prompts and receive missions. On the home screen, users choose whether they are feeling “Low, flat or depressed,” “Anxious, nervous or worried”, or “Neither”. If one of the first two options is selected, a follow-up question asks “How distressing is it?” on a scale of 0 (not at all) to 10 (extremely). Users then select one of the 4 options that best describes the low mood or anxiety; rumination, feeling too emotional, feelings that stop you from doing things, physical effects. Users can also select “I can’t quit put my finger on it.”

The app then provides 5 suggested mission options. Users can read about the missions before you selecting one; if you don’t like the suggested missions, the app will generate 5 more. This is the main content of the app. When a user selects one of the missions, they receive a mission objective, an explanation of why it helps, and the mission type with a link to more info. Once users find one to try, they “Accept the Mission.” Once the activity is completed, users select “Mission Completed” and will be asked again to rate how they feel and how helpful the mission was.

Examples of missions for low mood include doing lunges or push-ups (physical), cleaning the bathroom (behavioral), writing a letter to someone who has made your life better (emotional), and repeating a helpful phrase 5 times (“my feelings make me uncomfortable right now but I can accept them”) (thought-based). Examples of missions for anxiety include listening to music with new ears (physical), preparing lunch (behavioral), calling a friend to ask about their day (emotional), and imagining how someone else would respond to your situation (thought-based). Many of the missions will be shown for both depressed and anxious moods, but several are specifically for one or the other. There is a large collection of missions, so mission options are repeated infrequently. Users can also select missions as favorites that will be displayed each time along with the 5 mission options.

Completed missions are recorded in the mission log, which shows the date completed and a record of how helpful it was. The stats page in the mission log displays missions completed, organized by low vs. anxious mood and type of mission. The more missions the user completes, the higher rank (level) they reach and the more achievement badges they receive. Rank levels are named for specific mountain peaks. (An early level is 2228 meter-tall Mt. Kosciuszko in Australia.) Achievement badges are based on type and number of missions completed. For example, users get a “Well-rounded” badge for completing all 4 types of missions, “Hat trick” for completing 3 missions in a row, “Athlete” for completing 5 physical missions, “Brainiac” for completing 5 thought-based missions, “Diligent” for completing 5 behavioral missions, and “Zen” for completing 5 emotional missions.

The app also states that the suggested missions will be tailored to the feedback given on completed missions. Custom missions and “Expeditions,” which are series of missions that target specific fears (public speaking, spiders, flying) using graded exposure, are also available for a charge ($4.99 USD).

Recommendations for Use

This app is mainly intended for consumers, though it could be used in collaboration with a clinician or therapist. It may be particularly good for people with some cognitive behavioral therapy (CBT) experience, i.e. those who are currently in or have previously engaged in CBT, who want a brush up or get between-session boosts targeting the behavioral components of CBT. The app may also be good for people who want suggested activities to help them learn effective coping strategies. However, there isn’t enough support or use of broader CBT principles for people with severe depression or anxiety, and the missions suggested when a user reports being highly distressed do not seem particularly tailored. 

A general consumer could use this app as a mood record and a source of suggestions for a variety of activities. By selecting “View All Missions” on the mission log, completed missions are organized by date. For each mission, the user can view date and time started and completed, original mood rating before selecting the mission, and helpfulness and mood rating improvement upon completing the mission. This function serves more as a record of mood type and intensity than as a continuous tracking tool.  It appears that moods are only recorded and displayed for the user when the mission is completed. A diligent user could view this record to understand which missions impacted their mood the most.

While it is not intended for a clinician to use, Mood Mission could be a prompt for discussing with a patient coping strategies and psychoeducation on the connections between mood, thoughts, behaviors, and emotions. It is not clear how long it is intended for people use the app. It could provide some immediate relief in moderately distressing situations. Longer understanding and improvement could take weeks of use. At 30 days the user is again prompted to take the assessments though this information appears to be for internal app evaluation.

Content

The app contains evidence-based content addressing primarily the behavioral part of CBT. The app includes some behavioral activation techniques and psychoeducation about CBT and the relationships between cognition, emotion, behavior, and physical responses. The quality of information and purpose are clear, though the app itself does not include important CBT components like recognizing and naming automatic thoughts and cognitive distortions, or activities like keeping a thought record. The mission log is a helpful record of the date and time of moods and which missions were helpful in reducing distress, but does not include prompts or features for noting precipitating circumstances and events or situations that preceded the mood. There is little guidance on tracking or reframing automatic thoughts, though some of the cognitive/thought-based missions offer helpful ways to reframe one’s thoughts. The app also does not allow the user to record feeling good or positive mood other than rating one’s distress as “not at all.” Nevertheless, the primary content of giving thought-, emotion-, behavior-, and physical-based activities as coping options in response to low moods and anxiety is done well.

Ease of Use and User Experience

The app is easy to navigate and learn to use. The details of the missions themselves have a decent amount of text with comprehensive and well-written information. The profile, mission log, other support options, and expeditions are easy to find and most pages have a “back” link. The achievement badges incentivize users to try multiple types of missions and complete more missions.

However, it is not entirely clear how to best use the mission log or how the mission log could be used to help the user see trends in patterns of moods and helpfulness of missions. Beyond a reminder of the most recent missions, the user has to tap through each completed mission listing to view the mood record and helpfulness numeric data. This is somewhat cumbersome for gaining personal insight and promoting ongoing use.

Also of note, the iPhone version of the app requires entering an email and password for almost every use, and push notifications inquiring about one’s mood were infrequent and inconsistent. There don’t seem to be these issues on the Android version, though with Samsung Galaxy users need to use the back button in the app and not on the device.

Visual Design and User Interface

The aesthetics of the app are very appealing, with bright, warm colors (neon pink, orange, green, and blue) and silhouettes of mountain climbing scenes. The text is white on the colored background, and while it is often small, the main activity buttons for navigation are in boxes with larger fonts. The small text in the mission explanations may be hard to read for some users. It would be nice if the mission log displayed moods and missions in a way that the user could learn from a bit more. For example, a temporal display of mood ratings over time, the ability to note location and precipitating circumstances for each attempted mission, or highlights of the most helpful missions could augment and synthesize the Mood Mission information for the users. Nevertheless, the primary the mission suggestion features are clean and straightforward.

 

Overall Impression

MoodMission is a likeable and attractive app that will help users begin to understand their moods and learn a variety of coping skills for depressed and anxious moods. The act of opening the app and selecting one’s mood and how it is affecting them increases self-awareness and many of the missions serve to break thought cycles that often make us feel “stuck.” Several of the missions may be impractical if one is at work or on a bus, for example, so it requires a higher level of motivation or ability to follow through for more intensive activities. The app could also be improved by allowing users to input situational information and explore individualized cognitive aspects of depressed and anxious thoughts. Overall, however, the large number and variety of missions are the primary feature of this app that will help motivated users experiencing depression and/or anxiety to identify and practice coping and mood-improving activities.

References

Greenberger, D., & Padesky, C. A. (2015). Mind over mood: Change how you feel by changing the way you think: Guilford Publications.

Rachman, S. (2015). The evolution of behaviour therapy and cognitive behaviour therapy. Behaviour Research and Therapy, 64, 1-8. doi:https://doi.org/10.1016/j.brat.2014.10.006

Torous, J., Levin, M. E., Ahern, D. K., & Oser, M. L. (2017). Cognitive behavioral mobile applications: clinical studies, marketplace overview, and research agenda. Cognitive and Behavioral Practice, 24(2), 215-225.

Wenzel, A. (2017). Basic Strategies of Cognitive Behavioral Therapy. Psychiatric Clinics of North America, 40(4), 597-609. doi:https://doi.org/10.1016/j.psc.2017.07.001