How to navigate the offerings of mental-health apps

A quick search for “anxiety,” “depression” or “mental health” in Apple’s App Store or on Google Play returns a dizzying array of results. Offerings include games for stress relief, meditation guides, mood trackers, and tools intended to tackle such conditions as post-traumatic stress disorder, obsessive-compulsive disorder, schizophrenia, and more. But regardless of function, many of these apps tout variations of the same promise: They’ll help you feel better.

Amid the coronavirus pandemic, mobile mental-health apps have experienced a “surge in growth,” responding to an increased need for support as many have been impacted by the psychological toll of 2020, said Adam Haim, chief of the National Institute of Mental Health’s Treatment and Preventive Intervention Research Branch. In January, ahead of the pandemic, the American Psychological Association estimated that there were already as many as 20,000 apps available for download.

“The barriers to developing and selling or releasing mental-health apps are very low, and currently the market is flooded,” Haim said. “It’s hard for consumers, and in some cases clinicians, to identify what’s evidence-based and might work versus what does not include an evidence base and may in some cases be harmful.”

Still, Haim and other experts said apps can be a helpful resource. “Having a game plan going into such a chaotic marketplace is going to really help you make a better decision, a more informed decision, and just a faster decision,” said John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston.

Here’s what you need to know about mental-health apps and how to find the right one for you.

Apps should be viewed as a supplement to therapy, especially for people who have serious mental-health disorders, said psychologist Charmain Jackman, founder of InnoPsych in Massachusetts, a nationwide directory of therapists of color. “They’re not designed to provide that level of care.”

Even those seeking help with more mild conditions could benefit from human support, said Stephen Schueller, an associate professor of psychological science and informatics at the University of California-Irvine.

Research has shown that when apps are used by themselves without human support, they tend to have “consistent but small effects,” Schueller said. “On average, people get a little bit of a boost in their mental health from using these if they’re used by themselves. If they’re used in conjunction with a human supporter, we actually see benefits that are as large as those seen in traditional face-to-face therapy.”

A 2019 study of popular mental-health apps published in the Journal of Medical Internet Research analyzed how often the apps were opened after download and found that rates dropped by more than 80% within the first 10 days.

Having a coach, who does not have to be a licensed professional, to guide you through using the app while offering encouragement appears to have a positive effect on keeping people more engaged in a meaningful way, Torous said. He noted that some apps can connect paying users to a coach or therapist.

“The best evidence suggests that you’re going to get the best results from an app that you can stick with,” he said.

With so many apps to choose from, experts suggest getting guidance from a trusted resource, such as a health-care provider. Jackman said she works with her clients to find apps, noting, “I never recommend anything that I would not personally use myself.”

Factors to evaluate include credibility, supporting scientific evidence, privacy and ease of use, which can be a complex process for consumers to navigate on their own, Torous said. Typical measures such as star ratings and number of downloads “really just tell you what’s popular,” he added. “But that has no correlation to ‘Is it going to be helpful for you?’ So it’s certainly tricky for a consumer to make a decision.”

Similarly, “cost does not necessarily dictate quality,” Haim said.

To help steer people toward appropriate apps, Torous and a team of researchers launched a searchable online database (apps.digitalpsych.org), which draws on an evaluation framework that has been endorsed by the American Psychiatric Association. The database has assessments on about 260 apps and can generate a shortlist based on the criteria you select.

“We let people pick what’s important to them,” he said,.

Another independent app evaluation website is One Mind PsyberGuide (onemindpsyberguide.org), Haim said. The website reviews apps based on criteria developed by experts and provides numerical ratings. Some of the reviews also include feedback from professionals, who discuss how to use the app and its pros and cons, said Schueller, the site’s executive director.

Usually anything above a three out of five is considered a good score, Schueller said. But he emphasized that “there’s not one app for everyone.”

“Just because something has, like, a five on credibility does not mean, ‘That’s the app, I need to use it,’” he said. “There might be an app that’s a better fit for you that has, like, a four out of five on credibility.”

Take a hard look at the claims touted by mental-health apps. “About 97% of these products have no evidence base behind them whatsoever,” Schueller said.

App descriptions should mention scientific support. Although studies of individual apps aren’t always sound, Torous said just seeing whether developers have attempted to back up offerings with science can be a good screening metric. Schueller added that apps should also be frequently updated, which is a sign that “the development team is invested and committed to this app and will continue to improve it.”

It’s important to know who is behind the development of an app, experts said. Is a reputable mental-health organization involved? Was the app created with the help of well-established advisers? What are their credentials?

The U.S. Department of Veterans Affairs, for instance, has released a suite of free apps that experts say have thorough research support and were built by qualified people.

Though VA apps are largely focused on service members and veterans, Schueller said some are still relevant to the general population. He recommended Covid Coach, which was created by the VA’s National Center for PTSD to help people cope during the pandemic. It includes tools for self-care as well as mood trackers and graphs that visualize a user’s progress over time.

If no research into a particular app’s efficacy has been conducted, Haim suggested looking to see whether the platform uses treatment methods that have a solid evidence base, such as internet-based cognitive behavioral therapy, or CBT.

“You wouldn’t just take a pill without thinking about what the pill is going to do to your body,” he said. “Similarly, when downloading mental-health apps, it’s important to think about, ‘What is the underlying evidence base?’ and ‘How might this help me?’ "

Apps should have clearly stated data privacy policies that can be viewed before you sign up. Read them. Even when apps do have privacy policies, often “it’s pretty abysmal what your rights are in respect to your personal mental-health data,” Torous said. “You could be telling the app that you’re suicidal, you could be telling the app about sexual fantasies, you could be telling very personal, intimate information.”

A 2019 paper, which Torous co-authored, looked at three dozen smoking and depression apps and found that nearly a third did not have a privacy policy. Of the apps that did, many did not accurately disclose whether data would be shared with a third party, such as Google or Facebook.

Experts pointed to the privacy policy for VA mobile apps as an example of what consumers should look for.

Torous added: “If the app doesn’t have a privacy policy, that’s a huge red flag to walk away.”

Schueller said he often worries that people give up after trying just one app and having it not work for them. Instead, he recommended downloading two or three and seeing which one works best.

“That’s a really good strategy, especially if these things are freely available and have a free preview,” he said. “Consumers should look into whether they can imagine themselves using something like this.”

It’s worth it to be cautious, Torous said. “You’re not missing out by shopping around or being a little bit picky,” he said, adding, “If your alarm bells are going off, there’s probably a good reason they’re going off.”