Is There an App for That? A Review of Popular Apps for Depression,Anxiety, and Well-Being

Smartphone apps for mental health (MH apps) and wellness reach millions of people and have the potential to reduce the public health burden of common mental health problems. Thousands of MH apps are currently available, but real-world consumers generally gravitate toward a very small number of them. Given their widespread use and the lack of empirical data on their effects, understanding the content within MH apps is an important public health priority. An overview of the content within these apps could be an important resource for users, clinicians, researchers, and experts in digital health. Here, we offer summaries of the content within highly popular MH apps. Our aim is not to provide comprehensive coverage of the MH app space. Rather, we sought to describe a small number of highly popular MH apps in three common categories: meditation and mindfulness, journaling and self-monitoring, and AI chatbots. We downloaded the two most popular apps in each of these categories (respectively: Calm, Headspace; Reflectly, Daylio; Replika, Wysa). These six apps accounted for 83% of monthly active users of MH apps. For each app, we summarize information in four domains: intervention content, features that may contribute to engagement, the app’s target audience, and differences between the app’s free version and its premium version. In the years ahead, rigorous evaluations of highly popular MH apps will be needed. Until then, we hope that this overview helps readers stay up-to-date on the content within some of the most widely used digital mental health interventions.     

Les objets connectés et applications de santé : étude exploratoire des perceptions,usages (ou non) et contextes d’usage

In a contemporary context of major health challenges, the market of digital technologies has increasingly developed in past years. This article aims to explore main profiles of use in relation to connected objects and health apps, as well as attitudes related to uses, non-uses and contexts of use. Therefore, our objective is to contribute to the scientific debate by proposing an empirical study in psychology that focusses on the perspectives of consumers and non-consumers of these technologies in the French-speaking part of Switzerland. To do this, a survey was conducted among participants of a large public health exhibition (n = 760). According to our results, the majority of respondents declare not having a connected object/health app and a third of non-users does not intend to acquire such technologies. Also, there is a trend among younger generations to have a connected object/health app. Concerning the contexts of use, such technologies are employed to self-track physical activity and eating practices. The degree of satisfaction of such use is rather high. Given these results, our analyses point out a divide within our sample, between individuals who seem resistant and declare not willing to have this kind of technology and those who use it in the long run. These results cast new light upon concrete uses and contexts of use among consumers and non-consumers of connected objects/health apps beyond techno-scientific promises that prevail today in our societies.     

Acceptance factors of Zara's shopping app among fashion consumers during COVID-19

Online sales in the textile sector are undergoing a comprehensive renewal process as a result of COVID-19. This article analyzes how the pandemic has influenced the ZARA brand in its sales channel through its mobile application (app). This analysis has been carried out through the development of a UTAUT 2 model into which the constructs of Corporate Social Responsibility (CSR) and Design have been incorporated. Based on a sample of 736 Spanish people, an anonymous online questionnaire was distributed, and the responses were modeled using structural equations with Smart-PLS. From the results obtained and their interpretation, it is evident how, when purchasing textile products through the app, consumers are indifferent to the CSR of the brand, while design, ease of condition, and habit are shown as the elements that exert the greatest influence on the buyer. Despite being a growing trend within companies, the importance of CSR actions is not yet a determining factor in the intention to use fashion apps. Perhaps in a situation of uncertainty, consumers seek refuge in a well-known brand, without assessing whether the company is aligned with the interests of its environment. In times of COVID-19, users have changed their shopping habits, directly influencing online shopping. But what are the acceptance factors of these apps during this COVID-19 era? For this study, we have analyzed the ZARA fashion app through a sample of users in Spain, where the app has a higher number of active users.     

Healthcare at Your Fingertips: The Professional Ethics of Smartphone Health-Monitoring Applications

Health professionals are inundated by the surfeit of health apps while lacking guidance to help them critically evaluate whether a particular health-monitoring app is safe, likely to lead to clinical benefit, and not introduce additional liability. Our objective is not to argue for or against the use of mobile health-monitoring apps but to illuminate the associated ethical issues and provide recommendations to guide the ethical decision-making process for clinicians who are considering the use of a mobile health-monitoring app. To this end, the Canadian Code of Ethics for Psychologists is used as a framework to situate recommendations.     

Digital Mental Health Interventions for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.     

Comparing in-the-moment skill coaching effects from tailored versus non-tailored acceptance and commitment therapy mobile apps in a non-clinical sample

Mobile apps are promising for teaching how to practice psychological skills in high-risk and in vivo momentary situations, but there has been minimal research on the immediate effects of app-based skill coaching on mental health in-the-moment. This study analyzed the mobile app data in a non-clinical sample of 39 adults participating in a larger randomized controlled trial, with participants randomized to an acceptance and commitment therapy (ACT) mobile app that tailors skill coaching based on in-the-moment variables (n = 17) or an app that provides randomly selected skill coaching (n = 22). Data were collected before and after each ACT skill coaching session on proximal outcome (depression, anxiety, and engagement in meaningful activity) and ACT process variables. Multilevel models indicated significant immediate improvements on average following ACT skill coaching sessions on all proximal outcome and ACT process variables, although with relatively small effects ranging between 0.17 and 0.27 SD units change. Larger immediate pre-to-post effects from ACT coaching sessions were found for anxiety, experiential avoidance, and cognitive fusion in the tailored app versus random app condition. Overall, results suggest that an ACT app can have immediate, in-the-moment effects on psychological functioning, which may be enhanced by tailoring skills to current context.     

An Introduction to Core Competencies for the Use of Mobile Apps in Cognitive and Behavioral Practice

Mobile technologies have become increasingly pervasive and integral in our daily lives. A growing number of mobile applications are focused on health applications with many specifically focused on helping the prevention, treatment, and management of mental health issues. These apps are slowly being introduced into clinical settings, either being brought in by clients who themselves are using these tools or by health systems or providers. Unfortunately, most practicing providers obtained their clinical training before the advent of mobile health tools and methods. Thus, a critical need exists to develop and disseminate resources to develop the essential skills needed to adopt mobile health techniques. We discuss the five core competencies in mobile health care: evidence, integration, security and privacy, ethics, and cultural considerations. Although this paper will not fully prepare a provider to use mobile apps in their practice, it provides an introduction that will helpfully guide a provider to additional resources and additional ways to develop these competencies. Finally, we discuss the future directions of the field, including a growing differentiation of the impact of mobile apps on clinical care and the need for training models and experiences to match this differentiation.     

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications (‘apps’) and online trackers. A cross-sectional study (n = 276) was conducted to assess college students’ health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.     

Capitalizing on the potential of mobile health applications as behavioral interventions: A research agenda for calorie-tracking and activity-tracking applications

Mobile health applications (mHealth apps) are widely used tools that provide support for people seeking help managing their health in a particular behavioral domain (e.g., physical activity). Despite their popularity, evidence for the effectiveness of mHealth apps as stand-alone behavioral interventions is limited. Psychological and behavioral scientists can play a critical role in addressing this gap by pursuing programs of research that leverage basic behavioral science principles to test links between key features of mHealth apps (e.g., goal setting, feedback) and behavior change. To demonstrate this approach to evaluating mHealth apps, we systematically examine five key features of popular calorie-tracking and activity-tracking apps, explain how these features align with established behavior change techniques, discuss the evidence base for the effectiveness of these techniques within each behavioral domain, and situate predictions about how individual app features may promote behavior change in a conceptual model. Through this work, researchers can guide the design of mHealth apps and optimize them for facilitating sustained health behavior change.     

Mental health and North American Indian/Native communities: Cultural transactions,education, and regulation

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.     

Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.     

From self-reliers to expert-dependents: identifying classes based on health-related need for autonomy and need for external control among mobile users

ABSTRACT

Mobile health apps are seen as promising tools to support autonomous consumers in their quest for better health. However, individual differences in the need for autonomy and need for external control may impact the degree to which individuals perceive mobile health apps to be useful in their daily life. Using data from a representative sample of the Dutch population (N = 1,027), we applied latent class analysis to identify subtypes among mobile users based on their need for autonomy and need for external control, and to examine differences among these subtypes. We identified four subgroups: the self-reliers, confirmation-seekers, expert-dependents, and indifferents. Next to demographic differences, self-reliers and confirmation-seekers were generally more e-health literate and expressed more privacy concerns than the expert-dependents and indifferents. Our findings demonstrate that subgroups of people express different degrees of health-related need for autonomy and need for external control, which should be taken into account in online and mobile health communication efforts.     

Advocacy processes in mental health: a qualitative study

Advocates perform an important role in representing the rights of mental health consumers, especially since mental health consumers are often marginalized. Little is known about the processes advocates use to assist mental health consumers in navigating the health care system. This study details the manner in which advocates work together with mental health consumers and health professionals through presenting a qualitative synthesis of 60 case records. Four main themes emerged: negotiating on behalf of consumers during meetings with health professionals; liaising between consumers and health professionals outside of meetings; supporting consumer decision making without the involvement of health professionals; and involvement in legal processes. The findings of this study demonstrated that advocates were primarily oriented toward the protection of negative rights, but they also promoted positive rights.     

Variables which differentiate placement of adolescents into juvenile justice or mental health systems

Studies of the variables that determine whether an adolescent is placed in the mental health or juvenile justice system for treatment have led to conflicting conclusions based on impressionistic data. The primary hypothesis of this study--that demographic variables would and personality/psychopathology variables would not differentiate into which system a youth will be placed--was supported. Adolescents were studied at intake into both the juvenile justice system and the mental health system. Data were collected on demographics (structured interviews), personality/psychopathology (MMPI), social adjustment (CAAP), and academic achievement (PIAT). A discriminant function analysis identified eight statistically significant variables which differentiated the two groups. In order of decreasing importance they are: ethnicity, gender, MMPI-depression, previous mental health history, CAAP-productivity, drug use, parental marital history, and parental religious preference.     

Comparison of the Family Therapy Educational and Experience Requirements for Licensure or Certification in Six Mental Health Disciplines

In a review of literature on clinical licensure programs and certified mental health disciplines, no studies specifically compared didactic methods and clinical training standards for family-based interventions. Consequently, consumers and insurers of these services have no basis from which to evaluate the relative competency of each of the mental health disciplines in providing family-based interventions. This study used content analysis to examine the amount of family based training that is required by six core mental health disciplines (Clinical Psychology, Psychiatry, Psychiatric Nursing, Professional Counseling, Marriage and Family Therapy, and Social Work) in each of the 50 United States. Results indicate that a marriage and family therapist is required to have three times more family therapy coursework than any other professional mental health discipline. Also, before becoming licensed a marriage and family therapist, must complete 16 times more face-to-face family therapy hours than a mental health professional from any other discipline. Implications for consumers and practitioners are discussed.     

Stakeholders’ Perspectives on Community-Based Participatory Research to Enhance Mental Health Services

Historically, consumers of mental health services have not been given meaningful roles in research and change efforts related to the services they use. This is quickly changing as scholars and a growing number of funding bodies now call for greater consumer involvement in mental health services research and improvement. Amidst these calls, community‐based participatory research (CBPR) has emerged as an approach which holds unique promise for capitalizing on consumer involvement in mental health services research and change. Yet, there have been few discussions of the value added by this approach above and beyond that of traditional means of inquiry and enhancement in adult mental health services. The purpose of this paper is to add to this discussion an understanding of potential multilevel and multifaceted benefits associated with consumer‐involved CBPR. This is accomplished through presenting the first‐person accounts of four stakeholder groups who were part of a consumer‐involved CBPR project purposed to improve the services of a local community mental health center. We present these accounts with the hope that by illustrating the unique outcomes associated with CBPR, there will be invigorated interest in CBPR as a vehicle for consumer involvement in adult mental health services research and enhancement.