According to the National Institute of Mental Health (NIMH), technology has opened a new frontier in mental health care and data collection. Mobile devices like cell phones, smartphones, and tablets are giving the public, healthcare providers, and researchers new ways to access help, monitor progress, and increase understanding of mental well-being. Mobile mental health support can be very simple but effective. For example, anyone with a phone or computer can call, text, or chat the 988 Suicide and Crisis Lifeline at any time.
In the January/February 2024 Monitor on Psychology issue, the American Psychological Association (APA) released the Trends for 2024 Report. As part of this report, Heather Stringer wrote that mental health care is in high demand. Psychologists are leveraging tech and peers to meet the need. Amid a shortage of mental health providers, digital therapeutics could play an important role in providing support for underserved communities. Ninety percent of the public think there is a mental health crisis in the United States today, with half of young adults and one-third of all adults reporting that they have felt anxious either always or often in the past year, according to a 2022 survey conducted by the Kaiser Family Foundation and CNN. One-third of respondents could not get the mental health services they needed. When asked about the specific barriers to accessing care, 80% cited cost and more than 60% cited shame and stigma as the main obstacles. The shortage of mental health providers is also prohibitive, with 60% of psychologists reporting no openings for new patients, according to APA’s 2022 COVID-19 Practitioner Impact Survey.
Mental health providers throughout the country share a sense of urgency to find new ways to meet the high demand for services, and innovators are exploring interventions that diverge from traditional therapy models. The creative approaches include forms of support that require less time commitment from individuals, can be offered through digital devices, or both. Clinicians and researchers are seeing the benefits of these strategies in settings such as community clinics and college campuses, where psychologists experience a duty to serve and patients are open to exploring new options to access help.
“The lack of access to mental health care is an equity issue,” said Martyn Whittingham, PhD, a licensed psychologist in Ohio who developed a brief group therapy intervention. “Too often people from marginalized communities struggle to access quality psychotherapy, and these innovative strategies can provide support to many more people.”
Digital Interventions
The use of mental health apps continues to skyrocket. Certain apps, such as digital therapeutics, can cost between $300 and $1,500 per year and are typically not covered by insurance. Psychologists are advocating at the state and federal levels for health insurance organizations to cover the fees. Even though digital therapeutics have significant potential, psychologists are also “still figuring out how to use these tools in the context of clinical workflows,” said Stephen Schueller, Ph.D., an associate professor of psychology at the University of California, Irvine. “Evidence suggests that people benefit most from digital therapeutics when the apps are used in conjunction with some form of human support.” People may need coaching to troubleshoot technical problems and check-ins to see if symptoms are improving, he said.
Schueller recently launched a study using a digital therapeutic called SilverCloud that offers cognitive behavioral therapy skills and practice exercises to help people address anxiety, depression, insomnia, and other issues. His team is using the Spanish-language version and training Spanish-speaking laypeople from the community to coach monolingual Spanish-speaking patients to use the app effectively. Schueller’s team is exploring how the addition of human support to the SilverCloud intervention impacts clinical outcomes and engagement with the app and how to best integrate this digital therapeutic into care delivery.
Cognitive AI Agents
During a recent interview with Forbes in December 2023, Dr. Michelle Zhou, CEO at Juji, Inc., a cognitive AI platform, stated that the healthcare sector can utilize cognitive AI agents to enhance patient engagement, which in turn helps improve patient experience and outcomes. For example, LooperRoom, a mental wellness company at www.looperroom.com, adopts a Juji cognitive AI agent to go beyond answering the patient’s questions about their recent diagnosis or treatment options and instead partake in empathetic dialogue and help patients monitor and maintain their mental well-being. In general, through their interaction with patients, cognitive AI agents can infer each patient’s personality and deliver medical information or care instructions tailored to the patient’s background and personality, which makes it easier for the patient to comprehend and adhere to care instructions.
Other Technology Used for Mental Health Treatment
New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. Then, if the app detects a behavior change, it can signal that help is needed before a crisis occurs.
Some apps are stand-alone programs designed to improve memory or thinking skills. Other apps help people connect to a peer counselor or a health care professional.
Excitement about the huge range of opportunities technology offers for mental health treatment has led to a burst of development. Thousands of mental health apps are available in iTunes and Android app stores, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead people to wonder which apps they should trust.
Excitement about the huge range of opportunities technology offers for mental health treatment has led to a burst of development. Thousands of mental health apps are available in iTunes and Android app stores, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead people to wonder which apps they should trust.
Before focusing on the state of science and where it may lead, it’s important to look at the advantages and disadvantages of expanding mental health treatment and research into a mobile world.
What are the Pros and Cons of Mental Health Apps?
Mental health apps and other technology have a lot of potential, both for people seeking mental health care and mental health professionals providing such services. Some advantages of mobile care technology include the following.
- Convenience: Allows treatment to take place anytime and anywhere, such as at home in the middle of the night or on a bus on the way to work, making it ideal for people who have trouble getting to in-person appointments
- Anonymity: Lets people receive treatment anonymously and privately from the comfort of their homes
- Introduction to care: Acts as a good first step for people who have been reluctant to seek mental health care in the past
- Lower cost: Makes care more affordable through apps that are free or cheaper than traditional in-person care
- Greater outreach: Helps mental health professionals offer treatment to people in remote areas or to large numbers of people in times of sudden need, like after a natural disaster or traumatic event
- Interest: Encourages people to continue therapy by making care more appealing and accessible than traditional in-person treatment
- 24-hour service: Provides around-the-clock monitoring or intervention
- Consistency: Offers the same treatment program to all people
- Support: Complements traditional therapy by extending in-person sessions, reinforcing new skills, and providing support and monitoring
- Data collection: Collects information, such as location, movement, phone use, and other data
Mental health technology offers great opportunities but also raises concerns. Addressing potential problems will be essential to ensuring that new apps provide benefits without causing harm. Although apps are becoming more appealing and user-friendly, we need more information on their effectiveness.
The following are some limitations of the technology that researchers and developers are trying to answer questions about.
- Effectiveness: Is the app supported by scientific evidence showing that it works and works as well as traditional in-person methods?
- Audience: Does the app work equally well for all people it is meant to help?
- Privacy: How does the app maker guarantee users’ privacy, considering many apps deal with sensitive personal information?
- Guidance: How do people determine if an app is effective when no industry-wide standards exist for evaluating quality?
- Regulation: Who should regulate mental health technology and the data it generates?
- Overselling: Does the app promise more than it delivers and turn people away from using other, more effective therapies?
What are current Trends in App Development?
Research and engineering teams are combining their skills to address a wide range of mental health concerns. For instance, intervention apps may help people quit smoking; manage symptoms of anxiety, depression, eating disorders, post-traumatic stress, or insomnia; and more. Some popular areas of app development include the following.
Self-Management
Self-management apps involve people putting information into the app to receive feedback. For example, they might use the app to set medication reminders or access tools for managing stress, anxiety, or sleep problems. Some software can use additional equipment to track heart rate, breathing patterns, blood pressure, and so forth to help people monitor their progress and receive feedback.
Improve Thinking Skills
Cognitive remediation apps help people improve their thinking skills. These apps are often designed for people with serious mental illnesses who may have distorted or unhelpful ways of thinking or hold inaccurate beliefs.
Skills Training
Skill training apps may feel more like games than other mental health apps as they help people learn new coping or thinking skills. These apps might involve watching an educational video about anxiety management or the importance of social support, for example. People then pick new strategies to try and use the app to track how often they practice those new skills.
Illness Management and Supported Care
Illness management and supported care apps provide additional support by allowing people to interact with another person. The app may connect people with peer support or send information to a trained healthcare provider who can offer guidance and therapy options. Researchers are working to learn how much human interaction people need for app-based treatments to be effective.
Passive Symptom Tracking
Symptom tracking apps collect data using the sensors built into smartphones. The sensors might record movement patterns, social interactions (such as the number of texts and phone calls), behavior at different times of day, vocal tone and speed, and more. In the future, apps may be able to analyze these data to determine a person’s real-time state of mind. Such apps may also recognize changes in behavior patterns that signal an episode of mania, depression, or psychosis before it occurs. Although an app may not replace a mental health professional, it can alert caregivers when someone needs additional help. The goal is to create apps that support a range of people, including those with serious mental illnesses.
Data Collection
Data collection apps gather data without any help from the person using them. Receiving widescale information from many people at the same time can increase researchers’ understanding of mental health and help them develop better interventions.
Conducting Research
Apps can help conduct research. For example, Dr. Patricia Areán’s pioneering BRIGHTEN study showed that research via a smartphone app is a reality. The BRIGHTEN study was remarkable because it used technology to both deliver treatment and conduct research. In other words, the research team used technology to recruit, screen, enroll, treat, and assess participants. BRIGHTEN was especially exciting because the study showed that technology can be an efficient way to test promising new treatments, while also highlighting the need to make those treatments engaging.
Who creates Mental Health Apps?
Developing mental health apps and other technology requires a partnership between mental health professionals and software engineers. Researchers have found that interventions are most effective when people like them, are engaged in them and want to continue using them. Behavioral health apps work best when they combine engineers’ skills for making an app easy to use and entertaining with providers’ skills for providing effective treatment options. Researchers and engineers are developing and testing apps that do everything from managing medications to teaching coping skills to predicting when someone may need emotional help.
Who evaluates Mental Health Apps?
There are no review boards, checklists, or widely accepted rules for evaluating or choosing a mental health app or other technology. Most apps do not have peer-reviewed research to support their claims, and it is unlikely that every mental health app will go through a randomized clinical research trial to test its effectiveness. One reason is that testing is a slow process, and technology evolves quickly. By the time an app has been put through rigorous scientific testing, the original technology may be outdated.
Currently, there are no national standards for evaluating the effectiveness of the hundreds of available mental health apps. People should be cautious about trusting an app. However, there are a few suggestions for finding an app that may work for you:
- Ask a trusted healthcare provider for a recommendation. Some larger providers may offer several apps and collect data on their use.
- Check to see if the app offers recommendations for what to do if symptoms get worse or there is a psychiatric emergency. Know how to get help if needed.
- Decide if you want an app that is completely automated versus an app that offers opportunities for contact with a trained professional.
- Search for information on the app developer, including their credentials and experience.
- Beware of misleading logos. The National Institute of Mental Health (NIMH) has not developed and does not endorse any apps. However, some app developers have unlawfully used the NIMH logo to market their products.
- Search the PubMed database offered by the National Library of Medicine. This resource contains articles on a wide range of research topics, including mental health app development.
- If you cannot find information about a particular app, check to see if the app is based on a treatment that has been tested. For example, research has shown that internet-based cognitive behavior therapy (CBT) is as effective as conventional CBT for disorders that include depression, anxiety, social anxiety disorder, and panic disorder.
- Try it. If you’re interested in an app, test it for a few days and decide if it’s easy to use, holds your attention, and is something you want to continue using. An app is only effective if it keeps you engaged.
NIMH has awarded over 400 grants for technology-enhanced mental health interventions. NIMH staff continue to actively review and evaluate research grants related to mental health technology.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.
