How To Choose A Mental Health App?

The best answer to the title of this post is to first explain what apps can do. Once you know what’s available, then you can make more informed decisions on how to choose.
 
There Are Two Main Categories for Mental Health Apps

1. Wellness. These are for minor problems or self-improvement.
2. Impaired function, i.e., diagnosable disorders.

      The second category can be subdivided into two types:

• Self-help
• Integration with therapists.

 
The vast majority of apps are for wellness. Examples include those focused on meditation, journaling, and trackers for thoughts or emotions. One review found that only 4.7% of free mobile apps available on the iPhone or Android app stores were designed for individuals with diagnosable disorders. The remainder were for wellness (Lau et al., 2020).
 
I and my colleague published a review that included both free and paid apps with similar results. We found 676 apps self-proclaimed as “mental health,” but only 163 (24%) performed functions that would traditionally only be done in clinic settings (Pacheco & Scheeringa, 2022).
              
Impaired Function apps: Self-Help Versus Integrated With A Therapist
 
Self-help may be preferred before committing to the cost, time, and effort of seeing a professional therapist. This may be the only option for individuals who live in rural and underserved areas. Examples include a menu of modules for teaching and practicing techniques of cognitive behavioral therapy (CBT), acceptance and commitment therapy, and dialectical behavior therapy, or a chatbot that can fluidly suggest a range of techniques used in anxiety or depression therapies.
 
Apps designed for integration with therapists include full protocols (e.g., CBT) that are like a paper workbook, but digitized, to supplement in-person sessions. There are also a few apps that show data only to therapists, such as assessment results that suggest diagnoses, and symptom trackers to alert therapists in real-time about lack of progress.
 
Things to Look For
 
It is challenging to recommend apps because it is difficult to rate them for several reasons. Patients are complex and one size does not fit all. Satisfaction is subjective; one person’s fondness for quantitative data is another person’s loathing. Quality, ease of use, and cost vary quite a bit (just like live therapists!).
 
Third-party sites that list and review apps (e.g., OneMind PsyberGuide or Mental Health Index and Navigation Database) tend to focus on usability and privacy, and, unfortunately, have limited information on whether apps really help. Therapists may have recommendations based on their experience but most therapists do not have a wide range of experience with apps.
 
Does an app need a randomized controlled trial (RCT)? No. While RCT evidence has been the gold standard for showing effectiveness of psychotherapy and medication, the vast majority of apps are simply packaging tried-and-true methods into a digital, mobile format.
 
Another strategy for choosing apps is word of mouth; scroll through third-party review sites and forums where users give their personal experiences (e.g., Quora, Reddit, and some disorder-specific organizations). Be wary of non-specific praise that can be paid reviews trying to game the system, and hand-picked testimonials on company home pages.
 
Lastly, take advantage of free trials to try out different apps but be cautious about requiring a credit card up front. Check for complaints in review sections within app store profiles of not being able to cancel subscriptions easily.
 
I hope that with time, competition, and more users voicing their opinions, the marketplace of top-quality apps will eventually become clearer.
 
​
Michael Scheeringa, MD, founder
 
Postscript: Scheeringa Mind Company’s Therapy Fidelity app is for integration with therapists. Therapists register and pay for the app, and then they are allowed to invite unlimited numbers of patients to their accounts. If you want to try it as a patient, ask your therapist to sign up (they get a free 30-day trial period without requiring a credit card). The cost is only $3.00/month.
 
REFERENCES
 
Lau, N., O'Daffer, A., Colt, S., Yi-Frazier, J. P., Palermo, T. M., McCauley, E., & Rosenberg, A. R. (2020). Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review. JMIR mHealth uHealth, 8(5), e17798. https://doi.org/10.2196/17798
 
Pacheco CR, Scheeringa MS (online 8/19/22) Clinical wisdom in the age of computer apps: A systematic review of mental health apps. the Cognitive Behaviour Therapist 15:e40 doi:10.1017/S1754470X22000368.