If you were experiencing mental health challenges, what options would you consider for support? You may search for counselling, take medication, or you could even download an app. It’s true, there is an extensively wide range of mental health apps available to support mental health challenges. From mood trackers to chatbots, digital health companies have innovated to bring the power of modern psychology to our trouser pockets. 

Such an uptake in available apps may serve an important need, with the World Health Organisation reporting that one out of every four people worldwide will experience a mental health challenge at one point in their lives. However, is the surge in development of mental health apps the next step in the evolution of medicine and psychology, or is Silicon Valley attempting to cash in on a rapidly growing market? More importantly, as many of the apps that are already available are not backed by modern science, which ones can you trust?

We have thousands of mental health apps at our fingertips. Which ones are worthy of receiving our trust?

A History Of Mental Health Treatment

To answer these questions, let’s start by looking at the history of mental health treatment, and why online treatments are on the rise. In the 1950’s and 1960’s, the field of Psychology began to display a compelling evidence-basis for psychological interventions (treatments designed to address mental health conditions such as anxiety and depression). Classic interventions such as Cognitive Behavioural Therapy (CBT) gained a lot of traction in the scientific community as they began to be studied by many researchers with large samples of participants engaging with treatments suchlike CBT.

After the scientific community recognised their potential, healthcare providers such as the NHS, took to their adoption. At the time however, all of these treatments and therapies required the presence of an in-person clinician. Following the development of such face-to-face treatments, psychological research in the early 2000’s later turned to investigating guided self-help (interventions and exercises that can be completed in the user’s own time by following an instructional guide, such as with mindfulness meditations). With this came an industry-changing opportunity, to offer support to the masses without the need of a clinician to direct a psychological intervention. Most of these original guided self-help interventions were text-based, due to relatively slower internet speeds and technological limitations facing the incorporation of multimedia on more primitive computers. 

Today, now that five billion people have access to a smartphone and an internet connection, the ability to empower minds through digital interventions seems more feasible than ever. With such technological infrastructure in place, the world became ready to embrace the Smartphone Counsellor.

This now brings us to Woebot. Woebot is a living, though not entirely breathing, mental health companion. Through a chat-based setup, it uses an AI-powered bot to talk with users about their well-being, offering step-by-step guidance to improve their mental health.

A Look At Today’s Mental Health Apps

Woebot’s release marked the commencement of a paradigm shift in the capabilities of internet-based psychological interventions. By offering guidance which previously only belonged in a counsellor’s office, mental health support was democratised and made available to everyone through their own phones. Woebot takes a scientific approach to assess their service and validate its effectiveness, extending upon the research which made it possible; online Cognitive Behavioural Therapy interventions.

The question is, should digital health technologies be considered effective platforms to address mental health challenges? In theory, yes. Studies which assess the effectiveness of online psychological interventions will measure changes to symptoms before and after the intervention, as well as comparing their results to person-to-person treatments. This allows the researchers to conclude if it is ready to be appropriately delivered to people using the already well-established mental health support services currently available. In fact, many of the mental health apps on the market have indeed demonstrated this.

What should concern mental health app users, however, is that the majority of apps available on the market seem to show little to no evidence of scientific backing. Research has identified that from a sample of 1500 depression-related mental health apps, only 2% had published research assessing their effectiveness. Even the NHS, which offers a list of 14 “trusted” mental health apps which they recommend to the public, include 10 apps on the list which have no published evidence to show for their service.

Researchers have identified that the vast majority of mental health apps lack evidence to confirm their worth.

What Makes A Good Mental Health App?

Despite once seemingly going hand in hand, there is much disparity between research and development in today’s mental health app industry. It would be misleading to assume however, that science can not keep up with the pace set by technology. Publishing academic research is difficult to accomplish, as it requires experts to conduct complex studies and write articles fit for other academics. In addition to this, once results of a study are drafted and submitted to an academic journal, they are reviewed by other academics to very high standards. Studies must show robust methodology to be deemed credible, which many mental health app start-ups (without teams of psychologists) are unable to meet the demands of. This leads to such digital health companies launching their apps before implementing the necessary science to guarantee a promising level of efficacy, calling their value into question.

To make matters worse, the regulation of mental health apps is loosely defined and selective. Apps which claim to “boost mood” or to “promote happiness” often fly under the radar of the UK Medicines and Healthcare Products Regulatory Agency, which will only regulate apps that claim to “diagnose” and “treat” mental health challenges. In the eyes of many consumers however, the wordings surrounding both types of apps are synonymous. This results in trust often being bestowed upon apps which have shown no evidence in helping improve mental health outcomes.

So where does this leave us? What can we do to make sure that we are using mental health apps which show genuine promise of being helpful? Firstly, most websites of mental health apps will have an about section where they will detail their scientific approach to their app. With such a lack of science currently being used, having an evidence-based approach is a competitive advantage that mental health apps will want to flaunt. This should explain how they can ensure that their product is going to work for you. Secondly, when assessing mental health symptoms, apps will use different measurement questionnaires. Trusted questionnaires which capture the essence of mental health should be created and assessed by scientists. For example, Woebot measures the depression of its users using a questionnaire called the PHQ-9. uMore measures stress using the popular Perceived Stress Scale (PSS). Questionnaires that have been assessed will be dubbed as being clinically “validated”. Thirdly, reliable mental health apps may have accessible research publications which assess their effectiveness. To find these, you can access Google Scholar, a free search engine for academic articles. If you type in the name of a mental health app (such as “Woebot”), you should see popular results of “pilot studies” or “feasibility trials” which have tested the appropriateness of the app.

For the apps which do offer evidence of effective mental health treatment, the promise of offering high-quality mental health support is huge. This is the case for both the app users of today and also those of tomorrow. Interestingly, research has suggested that the effectiveness of a treatment depends more on the relationship a patient has with a therapist than how the treatment is administered. While this seems to be good news for counselors offering therapy sessions over Zoom during the Coronavirus lockdown, it is also promising for digital health technologies in 2020. With a reduced ability to travel to counselors in the local area and a reported increase in anxiety and depression since lockdown, digital health technologies may pave the way to how we administer mental health interventions in the coming years.

How Can Future Technology Empower 8 Billion Minds?

Looking to the future, continued research and development of digital health technologies will unlock the potential to empower 8 billion minds by 2030. As detailed in a report by the World Economic Forum; with mindful management, digital health technologies could be scaled to support mental health challenges to anyone with internet access. With the United Nations advocating for an open, accessible and nurtured internet access made available to all, and projects like Elon Musk’s Starlink attempting to broadcast internet connectivity via satellite to the most rural of areas, ubiquitous mental health support may soon always be available.

Satellite technologies have the potential to beam Wi-fi connections across the globe. What might this mean for the adoption of mental health apps worldwide?

It is now the time for digital health technologies to develop evidence-based and ethical solutions for the mental healthcare industry. As consumers and regulators become mindful of the need for the research backing of mental health apps, digital health technologies will focus on developing apps rooted in science. A science which when paired with the rapid advancements in technology, will bring mental health support powered by modern psychology to our trouser pockets.

Written by Alejandro Serrano Saunders
Written by Alejandro Serrano Saunders

Alejandro is the Chief-Scientific Officer of uMore, the AI-powered mental well-being tracker.

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