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Choosing a mental health app

    With therapists in high demand and long waiting lists that make it difficult to find a healthcare provider, using a mental health app may seem like a tempting and relatively inexpensive way to get help.

    These apps claim to help with issues as diverse as addiction, insomnia, anxiety, and schizophrenia, often using tools such as games, therapy chatbots, or mood-tracking diaries. But most are not regulated. While some are considered useful and safe, others may have shaky (or nonexistent) privacy policies and a lack of high-quality research showing the apps live up to their marketing claims.

    Stephen Schueller, the executive director of One Mind PsyberGuide, a nonprofit project that reviews mental health apps, said the lack of regulation has created a “wild west” that was exacerbated when the Food and Drug Administration pushed its demands for digital psychiatry products. eased in 2020.

    It’s difficult to determine the exact number of mental health apps available, but according to a 2017 estimate, at least 10,000 were available for download. And these digital products are turning into a lucrative business. Late last year, Deloitte Global projected global spending on mobile mental health applications to be nearly $500 million by 2022.

    So how do you make an informed decision to add one to your phone? We asked several experts for advice.

    In general, mental health apps can help people understand how their thoughts, feelings, and actions interact, says Dr. John Torous, the director of the division of digital psychiatry at Beth Israel Deaconess Medical Center. They may also help facilitate the skills patients learn during therapy, he added.

    dr. Stephanie Collier, director of education in the division of geriatric psychiatry at McLean Hospital, noted that mental health apps “can work well alongside physical activity goals, such as pedometers,” because exercise can help reduce anxiety and depressive symptoms.

    “In the same way,” she said, “apps that teach skills like deep breathing can be helpful for anyone experiencing stress — whether stress is the result of an anxiety disorder or simply circumstance.”

    However, for some people, apps are not that suitable.

    Apps work best when people are motivated and have mild illness, said Dr. Necklace. “People with moderate or severe depression may not be motivated enough because of their illness to complete modules on a mobile app.”

    No, and certainly not if you have obstructive complaints.

    “These are not standalone treatments,” said Dr. Necklace. “But they can be effective when used along with therapy.”

    Ideally, mental health apps teach skills or provide education, said Vaile Wright, the senior director of healthcare innovation at the American Psychological Association.

    “It could be this opening to think about ‘Maybe I should get some more professional help,'” she said.

    dr. Torous offers his patients a free app called MindLAMP, which he created to improve their mental health treatments. It tracks people’s sleep patterns, physical activities, and changes in symptoms; it can also adjust the “homework” that therapists give their patients.

    For the most part, no. The Food and Drug Administration regulates a small subset of apps that provide treatment or diagnosis, or are linked to regulated medical devices. But most mental wellness apps are not subject to government oversight.

    For example, some apps make unsubstantiated marketing claims, warn experts, or worse, provide inaccurate and potentially harmful information.

    “The number of products far outweighs the research evidence out there,” says Dr. Schueller, who is also a clinical psychologist and associate professor at the University of California, Irvine. “Unfortunately, much of the research that exists in this area is done internally by companies,” he added, rather than unbiased outside groups.

    In addition, there is no requirement that all wellness apps comply with the Health Insurance Portability and Accountability Act, known as HIPAA, which governs the privacy of a patient’s medical records.

    In a recent article, Dr. Torous and his colleagues identified regulatory gaps in digital health apps, unearthing several issues that could arise, such as inaccurate phone numbers for suicide crisis helplines. The paper also highlighted a previous study that found that 29 of the 36 top-ranked depression and smoking cessation apps shared user data with Facebook or Google, but only 12 accurately disclosed this in their privacy policies.

    And in March, a study concluded that an app created to help people with schizophrenia outperformed a placebo (in this case, a digital countdown timer).

    “All of these apps that claim to be effective in early or preliminary or feasibility studies probably need to study themselves with higher quality science,” said Dr. torous.

    Finally, just because an app is popular in the online marketplace doesn’t mean it will be safer or more effective.

    “As a clinician who has been using apps in healthcare for over five years, understanding which apps should suit patients has always been difficult,” said Dr. torous. “You really have to think about how we can respect people’s individual backgrounds, preferences and needs.”

    Rather than looking for the “best app” or the one with the most ratings, try to make an informed decision about which app is best for you, he added.

    One place to start research is the Mind Apps website, which was created by clinicians at Beth Israel Lahey Health in Massachusetts. It has rated more than 600 apps and is updated every six months. Reviewers look at factors such as: costs, security and privacy issues and whether the app is backed by research.

    Another website, One Mind PsyberGuide, evaluates health apps for credibility, user experience, and transparency of privacy practices. The project, which is affiliated with the University of California, Irvine, has more than 200 apps in its database and is reviewed every year.

    While MindApps and One Mind Psyberguide both provide an overview of an app’s privacy policy, you may want to dive into the details yourself.

    Look at what kind of information it collects, its security measures, and whether it sells information to third parties or uses information for advertising, said Dr. Necklace.

    In fact, less than half of depression mobile apps have privacy policies, according to a 2019 study, and most privacy policies aren’t provided until users enter their information.

    “It’s no wonder some people have reservations about using such mobile apps if you don’t know if and how your data is being used,” said the study’s lead author, Kristen O’Loughlin, a graduate research assistant at Virginia Commonwealth University. School of Medicine.

    Choose your app based on the information available and your own comfort level with disclosing personal information, she added.

    The answer to this question may depend on who you ask. But all the experts praised the mental wellness apps developed by the federal government, such as PTSD Coach; Mindfulness coach; and CPT Coach, for people who practice cognitive processing therapy with a healthcare professional.

    These apps are not only well studied, but also free, with no hidden costs. They have an excellent privacy policy and state that personal information will never be shared with third parties.

    In addition to these apps, Dr. Necklace the following:

    • Breathe2Relax (an app designed by a US Department of Defense agency to teach abdominal breathing)

    • Virtual Hope Box (an app produced by the Defense Health Agency that provides support for emotional regulation and stress reduction)

      For more suggestions, check out this list of apps on the website of the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco. The list, which was compiled in consultation with Dr. Schueller, includes several free options.