Opening Google Play or the App Store and searching for mental health brings up hundreds of results: from meditation apps, to mood trackers, to sleep apps. In the current pandemic situation, many of us have probably made this search in an effort to tackle increasing stress. Elevated health and economic anxiety, burnout from working from home, and fewer social interactions are common problems many of us are facing. At the same time, access to mental health care has also become more limited, with a slow adoption of teletherapy. All of this makes it difficult to access necessary care and can exasperate existing mental health problems.
But are mental health apps the new-fangled self-help solution we have been looking for? On the surface, they offer a versatile and accessible package that can help anyone improve their mood and concentration. Some apps even go as far as claiming to alleviate symptoms of serious mental health problems such as depression and generalized anxiety disorder. However, these claims can be exaggerated while other problems with mental health apps remain unaddressed too.
Mental health apps and scientific evidence
The first and most obvious problem facing those looking for help is the sheer variety of mental health apps. From mindfulness and meditation, to journaling, to chatbot apps, it’s hard to know which application is best suited to your needs. Vague messaging can make understanding an app’s benefits difficult.
The bigger issue, however, is that the scientific evidence supporting mental health apps is mixed. While some research shows that various applications can have a positive effect, others cast doubt on their efficacy. One study found that scientific language was commonly used to support effectiveness claims, but these apps often included therapy techniques which are not literature supported.
Long-term effectiveness is also dubious. In a 2018 clinical review published in the Evidence-based Mental Health journal, researchers narrowed down low engagement as one of the biggest problems hindering the potential of mental health applications. They point out that 74% of users drop any health apps only after 10 uses. Similar results have been observed with various mental health focused apps too. This is not terribly surprising given that lack of motivation is a common feature of many mental health illnesses and problems.
“It is good that we have a lot of apps, but most of them are not useful to people using them. That’s why we see abandonment.”, shares John Torous, MD, a director of the digital psychiatry division in the Department of Psychiatry at Beth Israel Deaconess Medical Center. Speaking to 4I-MAG, he shared that lack of integration into existing mental health care contributes to low engagement too, especially for those suffering from more serious mental health issues: “The apps are often not based on evidence, they are not culturally appropriate, sometimes evidence appropriate, so they don’t get picked up by clinical teams very much”.
Another issue Dr Torous highlighted is that many apps overmarket small pilot studies, which are “set up to succeed”. Often, one control group is given the app and the other is given no mental health resources, which inevitably skews results in the favor of the application. This is why claims even from widely used mental health apps need to be taken with a grain of salt.
Two of the most popular categories among mental health apps are mindfulness and chatbot apps. Mindfulness apps in particular have seen a meteoric rise since the start of the year. According to analytics platform App Annie, downloads surged in March, seeing a 25% increase compared to the weekly average of January and February. Android users also spent more time using mindfulness apps than usual.
But what is mindfulness exactly? It is defined as an “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations”. Apps usually aim to help users reach this state through guided meditation, as well as breathing and sleeping exercises. This approach has been adopted by many popular applications, including Headspace, Calm, and Ten Percent Happier.
“Meditation can yield meaningful impacts on a variety of outcomes after even short doses and duration of practice. Sessions can take as little as ten minutes each day, and it doesn’t have to be daily. In fact, many studies show positive results with a consistent meditation practice three to four times a week.”, Dr. Megan Jones Bell, Headspace Chief Strategy and Science Officer, told 4I-MAG.
Studies have also shown that meditation can alleviate anxiety and stress, and mindfulness apps seem to be on the right path with it. They often see longer daily engagement compared to other mental health apps, with an average of 21 daily minutes per active user compared to 13 average for all apps. No singular reason for this has been pinpointed, but their guided nature can be a boon to those struggling to force themselves to do other tasks such as journaling, logging moods, and so on.
Nevertheless, it’s important to note that meditation is not a one-size-fits-all solution. Dr Torous also pointed out that sometimes evidence on how meditation works specifically in the mobile format is lacking.
Could AI hold the solution in the form of chatbot apps? Yes and no. A 2019 review of mental health chatbot studies notes that preliminary evidence is favorable, but that further research is needed to examine their effectiveness more thoroughly.
Nevertheless, these apps can often be very attractive to users experiencing isolation or to those who find it difficult to discuss their issues with a clinician. Afterall, some cultures still stigmatize seeking professional mental health care. The question is whether chatbots can truly provide the intervention and support that users seek.
A popular Android app, Wysa, combines mindfulness and chatbot functions, and has received plenty of positive reviews. One user shared that “The AI is a lot more helpful than I could have ever imagined.”, but not all reviews of its chatbot functionalities are glowing. “Wysa is a good listener but has no understanding of what you’re talking about.”, one reviewer said.
This disillusionment is a common problem among chatbot mental health apps. In our interview, Dr Torous told us that the problem is rooted in the technological capabilities of natural language processing: “Human language is very complex, especially around mental health where it can become very abstract.” According to him, this makes it hard to meaningfully engage with the app and for users to change how they view themselves as a result.
Mental health apps as preventative care
A different approach both users and apps can adopt is viewing apps as a preventative mental health measure. They can be contextualized as another valuable tool in your mental health arsenal rather than as self-help treatment only.
This is something popular mindfulness app Headspace has been working towards. “We believe that mental health is not only about diagnosable mental health conditions – it includes a full spectrum of mental wellness through severe mental illness. We have tried very hard as a brand to help inspire people to look after their mental health in a preventative manner”, Dr. Megan Jones Bell, Headspace Chief Strategy and Science Officer told 4I-MAG.
The company addresses this in various ways. Headspace strives to deliver a personalized experience by not only providing mindfulness and sleep exercises, but a slew of other content. That includes kindness, happiness, and fitness videos. Dr Bell shared that the Headspace’s Move tab is an integral part of the app: “The movement of the body can be harnessed as a form of mindfulness: it’s about bringing the mind back to the present while we run or move, focusing on our breath, the feeling of our feet hitting the ground, and noticing the sights and sounds around us.”
Additionally, Headspace offers a social Buddies feature. It has greatly helped with continued engagement – a common problem of many mental health apps. “Those who use the Buddies feature are 35% more likely to complete two or more pieces of content on Headspace the same day. Having a buddy also generally increases the likelihood of a user completing a single meditation, completing a meditation course, or completing expert guidance.”
The future of mental health apps
So, can apps become an integral part of mental health care in the future? There is a lot of potential, but there some crucial steps that need to be taken along the way.
The first is obtaining better scientific evidence on which methods work and which don’t, and how different users respond to them. Involving qualified clinicians and psychologists at the development stage could increase engagement and personalization, helping mental health apps to address critical needs. Many apps could also benefit from marketing themselves as the preventative tools they are.
However, according to Dr Torous, one of the most beneficial steps would be to integrate apps into existing mental health care. Apps could become central in what you do out of clinical sessions, helping you “learn new information about how you are doing, build emotional self-awareness, give you environmentally responsive and real-time information, recommendations, and exercises that are customized and personalized exactly to you.” This could be incredibly helpful to those suffering from more serious mental health conditions such as depression and anxiety.
As for his predictions for the future, Dr Torous told us this: “Maybe the standalone apps haven’t done so well but I think there’s this push towards integrating them into whole care. That synergy of working for the clinician and working for the patient, I think that will be very powerful but it’s only just emerging.”