With long NHS waiting lists for talking therapies, many of those living with mental health problems are turning to apps as an alternative solution, but could they be exacerbating the problem?
Over the last two years mental health apps have seen a huge surge in popularity, according to the mental health charity Mind. Inevitably the increasing use of smartphones has led people to look for support in new ways, with many now turning to apps.
Compared to paying for a weekly session with a private therapist, the main advantage of a mental health app is that there’s often no time or financial commitment. For those living in remote, rural areas, accessing face-to-face therapy can be particularly challenging and many still feel a stigma in seeking professional help.
The positives are real: “An app can reduce the time people are left without help, becoming an early support system or safety net, whilst waiting for face-to-face care,” says Simon Leigh, Health Economist for the health app finder ORCHA. “Later after a therapist has been seen, apps can reinforce strategies and track information.”
But first of all, what do we mean by mental health apps? They broadly fall into three categories:
- Mindfulness and meditation apps (such as Headspace and Calm)
- Screening apps (such as Moodpath) which aim to determine your mood via an online questionnaire and
- Treatment apps (such as MoodKit and Talkspace on-line therapy).
“Mindfulness and meditation apps can potentially be a great learning tool,” says Hilda Burke, psychotherapist and author of The Phone Addiction Workbook. “The ideal scenario is that you learn the technique, then use it off-line so you’re not dependent on your phone. However, many of these apps are built to be addictive, so there is a risk of becoming dependent on the very apps that were supposed to help you.”
She highlights the irony that our increased use of smartphones has been found in studies to be partly to blame for the rise in mental health problems, yet we are steering people back to their phones to try and solve the issue. Numerous studies have shown how bad it is for us to be on our phones just before bed and the moment we wake up, yet many of the meditation and mindfulness apps promote sleep meditations and morning wake-up meditations.
The other concern with mood-screening apps is what advice you’re given on receiving your result. So your app concludes you’re depressed, now what? When being diagnosed by a professional rather than an app, these questionnaires are conducted in person by a medical professional, who would then devise a suitable treatment plan, possibly combining medication and therapy. They are also able to pick up the hidden messages in your body language which may give even bigger clues as to how you’re feeling. Without that immediate follow-up plan, the app user could be left feeling even more anxious and alone.
points out that those suffering from depression or anxiety often have issues with cognitive impairment, motivation and drive, so once you’ve got your ‘result’ you’re even less likely to start reading up on what to do next than someone who’s mentally healthy. So being able to get users who are having mental health issues to stick to an app can be tricky. Her app is unusual in that it aims to boost the user’s mental health during play. At the moment it’s aimed at preventing mental health problems from arising, but in the future, she plans to add therapeutic features to the game so it can also help with treating problems.
Some treatment apps do offer a remote connection to real life therapists and studies have shown that some of these have comparable outcomes to face-to-face therapy. NICE is currently evaluating these apps and gathering real-world evidence to measure their effectiveness.
Burke points out the potential problem of there being no ‘time boundaries’ with apps which could lead to inappropriate use – for instance, users could get caught in the trap of lying awake worrying, playing with their treatment app, when in fact they would be better off trying to sleep. The phone offers up so many other things – chat, dating matches, news – so the risk is that what starts off as a desire for relaxation and calm can become a gateway to further stress and anxiety, thus making sleep even more elusive.
The lack of validation is a huge issue too, says Simon Leigh of ORCHA. “A review published in 2014 by the Karolinska Institute showed that some apps developed for the purpose of suicide prevention included some potentially harmful content, such as featuring descriptions of suicide and could in fact be used as a source of ideas by highly vulnerable people. This wasn’t the apps’ intended use, but because they hadn’t been adequately tested, this significant safety issue hadn’t been addressed.”
NICE’s evaluations of therapist-guided CBT apps (where users also have some digital or real life contact with a named therapist) includes full reviews from clinical psychologists to ensure they follow CBT therapy standards and that the app content is safe.
The experts we spoke to agree it’s essential that these apps are developed with input from both mental health professionals and sufferers themselves, and for them to be rigorously tested to see if they make a difference. For instance, the Happy Not Perfect App was three years in the making and was developed with the help of neuroscientists and psychologists. It includes ‘recharge’ sessions filled with mini-games, quick techniques and breathing exercises, a ‘burn bin’ to rid your mind of unhelpful thoughts and a daily gratitude list.
Similarly, the Zone app, founded by Saira Gill, was developed in partnership with neuroscientists and music therapists to make sure the content had the right elements, proven to boost mental health and peak performace. “For instance, we decided to create our own music from scratch so that it didn’t evoke any negative memories in the user and would therefore be ‘neutral’ “ whilst being tailored to each user
“Typically it takes a month of regular usage of a good quality app to see a difference”, Litvin points out. But even the best quality, officially approved apps should be used alongside real life, professional support, not instead of, advises Eva Critchley, Head of Digital at Mind.
“We want everyone who needs mental health support to be offered access to a range of high-quality treatments (which could include digital help) so that they can get the support that’s right for them when they need it.”
To make sure you’re getting the best out of an app, keep evaluating whether and how the app is helping you. Ideally only use apps found through portals such as the NHS Apps Library at or the health apps finder ORCHA which has a strict vetting process. Do make sure you’ve checked your online therapist is accredited by an official body such as the British Association for Counselling and Psychotherapy (BACP).