As studies of mental health become more prominent, novel ways to treat mental illness are being developed. A recent study by Northwestern University has shown that the use of technological applications on smartphones can help people with mental illnesses like depression and anxiety. Though these particular studies and applications are relatively new, smartphone applications that deal with mental health have been around for quite some time. However, with the wide range of applications offered, it is hard to assess which applications are truly effective and worth investing time and effort. Additionally, individual differences, including the differences in the severity of mental illnesses amongst individuals, play a part in the decision of whether to take advantage of these apps. As medicine becomes more modernized, the implementation of hi-tech resources like smartphone apps could allow medical treatment to reach larger groups of people such as teenagers and those that find personal treatment inconvenient. The use of smartphone apps to supposedly treat mental illnesses may extend the reach of medical treatment though their effectiveness, individual preference, and the place of technology in medical care overall must be considered.

The study at Northwestern University involved several mini-apps under the name Intellicare, which showed to treat the depression and anxiety of the people participating in the study.1, 2 The participants using Intellicare reported to have lessened depression and anxiety after using the apps provided by Intellicare about four times per day.2 The results of this study were linked to similar results from patients that take antidepressants or receive other medical therapies to treat the same illnesses. The mini-apps of Intellicare include features to decrease stress and worrying while aiding people in sleeping, focusing, and looking at themselves better to stay mentally healthy. Northwestern reported that those that were devoted to using the mini-apps often were the ones that experienced the most improvement.1,2 Intellicare also includes relaxation videos and motivational quotes and mantras that are reportedly based on self-improvement. The study lasted approximately eight weeks and the 96 participants of the study reported that they felt a 50 percent decrease in difficulties they faced from depression and anxiety.1, 2

While the results of the study at Northwestern were positive, they do not provide a one-size-fits-all approach to treating mental illness. David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine, acknowledged that one reason that the participants experienced this progress and felt better was that the apps were new and introduced a fresh take on dealing with depression and anxiety.2 That being said, the results may have differed over a longer-term once the fascination with the gadgets and videos of the apps wears off. This is common when starting any new task or challenge for the first time as people are initially fully committed and optimistic about an outcome but these feelings may waver.

Another issue with studying mental health and the Northwestern study in particular is that the only form of reporting available is that which is given by participants. Throughout the study, it was the participants that confirmed whether or not they felt more or less depressed as the study went on. This shows the problem with treating mental illnesses like depression and anxiety because there are no official parameters to show whether a treatment plan is working for someone or not. Unlike the rehabilitation of strokes or physically noticeable diseases, patients cannot get blood or brain scans to see whether they are cured or should keep using these apps or even seek professional help. Mental illness follows an unpredictable pattern and people can feel better one day and suddenly much worse the next. Some of the patients of the study can even experience confirmation bias. This means that they may say that they feel less depressed or anxious because only because they want to be less depressed or anxious for the sake of the study and to actually feel better. Sometimes when people want to see a result badly enough, they believe that it is so. Intellicare also announced that a study is available in the apps which pays people to give feedback (CITE).1,2 This only creates a financial incentive to report the result that the organization is looking for instead of what is really happening.

Since the only way to assess the effectiveness of smartphone apps in treating mental illnesses is to survey customers, different apps have their own ways of doing so. According to the ADAA, the Anxiety and Depression Association of America, their sponsored apps follow a “ratings key,” which includes criteria such as ease of use, effectiveness, personalization, feedback, and research evidence.3 However, this key is again based on the reviews of users of the app. Some people may find an app easy to use and specific to the kind of coaching and help that they need while others could see it differently. Even the research evidence field is based on evidence gathered from studying the people that have used the apps instead of clinical data and research that can be proven and replicated.

While smartphone apps do not introduce a guaranteed way to treat depression and anxiety, they do show important components of more successful treatments. The apps tested were made to be simple, understandable, and easy to maneuver. Many of the apps that are for treating mental illness are also free or very cheap compared to the cost of in-person therapies. This shows that people look for ways to improve their mental health that are not only effective but convenient and inexpensive. It is much easier to download an app and check it a few times a day rather than get dressed and spend hours speaking to professionals through paid sessions. In this case, like many, time is money and the ease provided by smartphone apps shows that apps can be an outlet for getting treatment if they are used correctly. Teenagers already use technology frequently to communicate with others. Tchiki Davis, a PhD student studying psychology at the University of California, Berkeley, stated that “Apps are a great way to reach people who aren’t currently getting services.” 4 Some people, even with time and money available, choose not to seek treatment because they feel uncomfortable with direct face-to-face therapy. These are reasons for people to look into these apps and determine for themselves whether they work.  By being user-friendly, they can help participants become more adaptable and self-sufficient as well. Some apps have journals that ask the user when and why they begin feeling anxious to pinpoint the causes of anxiety and what things people can avoid. Rewards points and even ‘good-job’ pop-ups can motivate people to keep writing and noting the root of their problems.

The personalization trait of medical health apps is important to consider in choosing an app to dedicate one’s time. In the Northwestern study, some participants reported to feel better from the relaxation videos and coaching videos while others felt better by rehearsing positive mantras.1,2 When it comes to depression and anxiety, every individual case is different. Therefore, caring for and treating each case must be different. Depression and anxiety can be caused by a variety of factors for different people and people could have specific techniques and habits that they use to feel better or improve their mood. Smartphone apps need to take these factors into account in order to treat a range of people, some of which could benefit more if using the apps in addition to in-person therapies or medications.

With Intellicare specifically, the mini-apps include motivational mantras, apps to help people sleep, and audio recordings and coaching to decrease stress.1,2 Available apps from other sources include Pacifica for treating anxiety, Breathe2Relax for mood instability, and even PTSD Coach for treating PTSD through positive thinking.5 Some apps use soothing music and images while others have interactive components like games and journals to track progress. This relief and progress in patients could be long-term but it could also be temporary and induced through using the app at a certain time. One thing that they all share in common is that they keep people engaged through various activities and games that keep people busy. This presents the question of whether people are actually feeling better or are just too busy to notice how they feel without using the apps.

While modern critiques of technology and smartphones involve the reliance on them, smartphone apps could be tied to the same dependency. If people see that the mini-apps make them momentarily happier or less anxious and depressed, then they will continue to use them and expect the same result. However, not only could people get tired of using these apps and not finding the comfort that they are looking for, but people can become dependent on the apps and see them as the only place they can find comfort. This could be a problem because, should people for some reason be unable to access the apps, they will relapse and feel even more anxious by being cut off from their source of relief. All things considered, this could of course be said about any medical treatment, but technology is far-reaching while in-person therapies use methods based on communication and learning to relate to others by stating feelings out loud to confront them. If an app malfunctions, is deleted, or feels monotonous, then recovery and good feelings could be jeopardized for some people. To battle this problem, apps should lead people on a path of self-improvement based on recognizing self-worth rather than needing an app to feel happy or translate anxiety into something useful. They must be free and not focused on subscriptions or profit which would require people to have a reason to keep using them rather than learn to be on their own and put their phones down.

Before managing the features of the apps themselves, the way apps approach treating mental illness needs to be reformed so that they are taken seriously and hold truth. Many people may dismiss the actual effectiveness of smartphones in treating depression. These days, it seems as if any problem is met with the response, “Don’t worry, there’s an app for that!”6 While this may be true to a certain degree, the fact that this response is used so often can diminish how much people believe it to be true. Sure, there may be an app to help one find a restaurant but an app to treat a draining illness like depression? That is out of the question because it so difficult that there cannot possibly be an app to cure it. With this thinking, the apps could be dismissed before they are even downloaded and tried out. Alternatively, if a simple app could get rid of depression, anxiety, PTSD, and stress then why is everyone not happy and pleasant all of the time? What use do we have for doctors other than healing physical wounds?

The appeal of smartphone apps and their link to medical treatment is that they promise ease and simplicity. Medicine is already a complex field and includes what some see as jargon that is a barrier to understanding conditions like depression and anxiety. People with these illnesses may be confused about how they feel or what their feelings mean and they are trying to find understanding. With so many treatments available, different costs, and different types of therapies and specialists, people might not know where to begin. While smartphone apps bypass the issue of finding the right treatment, they also all claim to cure conditions that they may or may not even treat. For example, the details section of the app Aura, states that “Aura is the simplest solution to reducing stress,” which asserts that by using Aura, everyone will experience reduced stress, guaranteed.7 Inducing certain feelings or preventing others can never be guaranteed. Furthermore, having every single one of the thousands of apps dedicated to treating anxiety say that they are the solution re-introduces the overwhelming problem of not knowing where to begin. Surely, all of these apps cannot be perfectly tailored to suit everyone and all of them eliminating depression completely is probably too good to be true. To gain credibility and remove clutter, apps should refrain from claiming that they get rid of mental illnesses. Instead, favorable options include helping individuals learn to manage their own stress and anxiety. This lessens the disappointment if a treatment does not work and also suggests that the apps only provide the framework for people to help themselves rather than depending on an app to do all of the legwork.   

While the effectiveness of smartphone applications in treating mental illnesses is subjective and subject to debate, apps can provide more information about the ways that mental health can be improved. Self-reported causes of anxiety and depression extend medical awareness of indicators that lead to anxious or unhappy feelings. The features of apps that people find most useful can suggest certain images, music, or quotes and activities that seem to make people feel better. By increasing access to qualified medical treatment, apps could help people learn how to manage mental illnesses or persuade them to seek in-person treatments better suited for them. As the world becomes more digital, medicine and mental health are becoming more flexible in extending their influence through mediums like apps to better battle disorders.  

References

1. Paul, Marla. New apps designed to reduce depression and anxiety as easily as checking your phone. Northwestern Now Web Site. https://news.northwestern.edu/stories/2017/01/apps-to-reduce-depression-anxiety/. Published January 05, 2017. Accessed March 14, 2017.
2. New apps designed to reduce depression, anxiety as easily as checking your phone. Science Daily Web site. https://www.sciencedaily.com/releases/2017/01/170105123102.htm. Published January 05, 2017. Accessed March 14, 2017.
3. Mental Health Apps. Anxiety and Depression Association of America Web Site. https://www.adaa.org/finding-help/mobile-apps. Accessed March 14, 2017.
4. Hullinger, Jessica. Can your smartphone treat depression? http://theweek.com/articles/552814/smartphone-treat-depression. Published May 4, 2015. Accessed March 14, 2017.
5. Mobile App: PTSD Coach. U.S. Department of Veterans Affairs Web Site. http://www.ptsd.va.gov/public/materials/apps/ptsdcoach.asp. Accessed March 14, 2017.
6. Bergland, Christopher. Anxious or Depressed? ‘Intellicare’ is an App Suite for That. Psychology Today Web Site. https://www.psychologytoday.com/blog/the-athletes-way/201701/anxious-or-depressed-intellicare-is-app-suite. Published January 05, 2017. Accessed March 17, 2017.
7. Aura: Mindfulness Daily – Stress and Anxiety Relief. iTunes Web Site. https://itunes.apple.com/us/app/aura-mindfulness-daily-stress-anxiety-relief/id1114223104?mt=8. Published March 03, 2017. Accessed March 14, 2017.