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Review by expert Jason Moehringer, PsyD

Pros

  • Provides CBT-based education on a variety of topics related to depression
  • Guides users through a simple cognitive restructuring exercise, with unlimited uses
  • Includes a simple mindful meditation activity
  • Uses well-established PHQ-9 questionnaire to provide feedback about severity of depressive symptoms
  • Some articles presented in both text and audio formats
  • Free to download and access does not require a subscription

Cons

  • CBT concepts are poorly cited and do not always reflect expert consensus
  • Interface is unintuitive and difficult to use
  • Both cognitive behavioral techniques included in the app (cognitive restructuring and mindful meditation) are somewhat simplistic and unengaging
  • Limited interactive components
  • Questionnaire results are not explained very well

Description

Depression CBT Self-Help Guide is an Android™ app for use with version 2.2 and later. The app was created by Monica A. Frank, Ph.D., a clinical and sports psychologist, d/b/a Excel At Life. Using principles of Cognitive Behavioral Therapy, the app provides basic information about depression and living with depressive illness. A unique feature is that the focus is on physical symptoms commonly associated with depression, such as low energy and sleep disturbances, as opposed to simply addressing sadness or low self-esteem. The developer takes the overarching perspective that depression is a physical illness that is exacerbated by stress and faulty thinking; while the underlying illness may be genetic and life-long, stress and problematic thinking can be managed or changed. Many of the informational articles are available in both text and audio formats, and some include suggestions for coping with stress or changing problematic thinking styles.

In addition to information, the app contains several guided mindful meditation exercises. These are intended to help users learn a simple relaxation technique that can help reduce the impact of stress. Users have unlimited access to these tools and can listen to them repeatedly for practice; however, there are only a limited number of options. The app also includes an electronic version of the Patient Health Questionnaire – 9 (PHQ-9), a brief, widely used questionnaire for assessing the severity of depressive symptoms. Users can also access this an unlimited number of times in order to keep track of their mood as they progress through the app.

Perhaps the most useful feature of this app is the Cognitive Diary, a guided cognitive restructuring activity. Cognitive restructuring is a core skill taught in cognitive behavioral therapy and can be helpful in identifying problematic thought patterns and replacing them with healthier alternatives. However, the Diary is almost entirely user-directed, with most interaction involving open-ended prompts, such as to enter a problematic thought from earlier in the day. While the lists of thought distortions and healthier alternative thoughts that are provided for users to select from when working through the diary are comprehensive, they are difficult to use due to their extreme length and inconsistent applicability.

Finally, the app states in multiple locations that it partners with a company called AchieveMint for the purpose of offering “cash rewards for engaging in the CBT activities” included in the app. The developer is careful to note in each case that they are not directly affiliated with AchieveMint, do not have control over data sent to AchieveMint, and are not responsible for negative outcomes stemming from any interactions with AchieveMint. Additionally, brief research into the AchieveMint program indicates that they are not accepting new members. As a result, this feature of the app is nonfunctional, and users should always be careful about submitting personal information to third-party organizations.

Security/Privacy/Data Sharing

The app was first launched in March 2012 and the current version (1.8) was launched in October 2014. The app has a clearly described privacy policy in which it is stated that only basic usage information is collected by the app for the purposes of making improvements, that any personal information is not shared with third parties (except AchieveMint for those who may have been able to opt-in at an earlier date), and that the only geo-location data collected is country of residence. It is also stated that the Google Backup Service is utilized by the app so that users can save their entries in the Cognitive Diary and their results on the PHQ-9, but that it cannot be guaranteed that this information will be maintained by Google and that this information may be subject to use by Google. No other disclosed information sharing or data gathering functions are included in the app.

Ease of Use and User Experience

The app utilizes cool, pleasant colors and obvious care has been taken to make it as enjoyable as possible for users given the limitations of the developer. Having said that, the user experience suffers significantly from the old-fashioned and unintuitive interface. Users who have difficulty reading or sustaining attention, or who have problems with extended use of screens, may be frustrated by the primarily text-based presentation of the information in the app. There are also few interactive exercises and limited options in the guided mindful meditation section, so users may find it hard to engage with the app over the long-term course of any depressive illness that they may have.

Scientific Basis

The app bases its educational materials, guided practice exercises, and therapeutic recommendations on Cognitive Behavioral Therapy, which is a well-researched category of treatments for depression. Unfortunately, the app focuses on only two clinical interventions (cognitive restructuring and mindful meditation/relaxation), excluding many traditional CBT components that have also been shown to be helpful in coping with depressive symptoms. Additionally, this app itself has not been studied in clinical trials or compared to other eMental Health programs.

Cost

The app is free to download and use, and no restrictions are placed on the user or any of the app’s features. No subscription is ever required.

Overall

This app is likely to increase awareness of the issues involved in living with depression, and has some very helpful information and suggestions for individuals who are trying to cope with depressive symptoms. It includes the PHQ-9, which is widely-used by mental health practitioners. It is also free to use, and therefore accessible to anyone with a smartphone. However, it is far from comprehensive in describing depression or offering suggestions for coping skills. It also has only very limited interactive components and the interface is old-fashioned and difficult to use. Therefore, while it may be a reasonable source of information and practice in the CBT skills it does include, it should not be the primary method for treating depressive symptoms for any person.

Review date: December 2015


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