The use of smartphone apps to treat mental health conditions like depression and anxiety is on the rise, but how do they stack up clinically?
An estimated three million Australians are living with depression and anxiety. For many, downloading an app is a quick and easy way to cope with their symptoms. Experts estimate there are more than 10,000 mental health apps available for public download, and they’re touted as the future of treatment as well as preventative care. But how do these apps stack up clinically – and are they as effective as face-to-face care from a therapist?
A recent survey by VicHealth found 30 per cent of Australians use apps to try to improve their health, and given the enormous number there are to choose from it’s not hard to see why. The problem is very few mental health apps have been professionally evaluated and even fewer have been rubber-stamped as evidence-based.
“Unfortunately, there are a lot of apps out there that claim to be evidence-based or evidence-informed, but what they really mean is they’re based on one or two very small studies that have been commissioned by people with a vested interest in the app,” says Dr Peter Baldwin from the Black Dog Institute.
Associate Professor Philip Batterham from the Centre for Mental Heath Research at the Australian National University says some apps can even be damaging to mental health. “Most mental health apps typically don’t have very good evidence for them,” he says. “There have been some reviews of mental health apps that have actually found harmful apps or apps giving harmful or incorrect information.”
It’s not all bad news. A number of well-designed apps have a solid evidence base and can be effective treatments for some of our most common mental health conditions. “There are evidence-based apps that are based on principles of cognitive, behavioural or related therapies which have been shown to be effective for reducing symptoms of depression and anxiety,” says Associate Professor Batterham.
Much of the research focuses on mild to moderate mental health problems. A landmark Australian-led study published in World Psychiatry found some apps can significantly reduce symptoms of depression, especially among people with mild to moderate symptoms. Likewise, a paper published last year in mHealth found some apps designed to treat depression had the greatest impact on people with less severe symptoms. Its findings suggested apps for anxiety were also effective, especially when combined with face-to-face or internet-based therapies.
In fact, evidence-based apps that include an element of therapist care – such as weekly phone calls to build on exercises completed through the app – can be just as effective as traditional psychological treatment.
“The apps that come with some therapist support are actually as effective as standard face-to-face treatment for people experiencing symptoms in the mild to moderate range,” says Dr Baldwin. “They’re a particularly good option for people who find it difficult to come and see a face-to-face therapist, and a confidential way of trying out mental health services.”
But it’s important to note there is currently no evidence to suggest that using apps alone can outperform standard psychological therapies or reduce the need for antidepressant medications.
Which apps are best?
It can be difficult to figure out which apps are evidence-based and effective, and which are not. Dr Baldwin says apps created by reputable organisations are usually a safe choice. “A good rule of thumb is if the app has been evaluated or associated with a large research institution, like a university or a research institute, it’s probably a good option,” he says.
Sites like the Department of Health’s headtohealth.gov.au and the Australian National University’s beacon.anu.edu.au, which Associate Professor Batterham helped to develop, contain databases of evidence-based apps.
Another effective strategy is to look for apps that are based on the principles of cognitive behavioural therapy – or ‘CBT’ – a psychological treatment based on the idea that how you think and act affects how you feel.
“Most of the types of therapies that have been shown to be useful for reducing symptoms of depression and anxiety are based on CBT,” says Associate Professor Batterham. “If an app suggests that it’s based on CBT it’s likely to be somewhat useful.”
Above all, Dr Baldwin says it pays to be cautious when you’re assessing mental health apps. “The number one thing I recommend is to be sceptical of claims that seem too good to be true and flashy marketing where the production value is much greater than the evidence behind it.”