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Is There An App For That? Experts Talk Digital Strategies of Mental Health and Wellness

Smartphones have tracked steps and heartbeats, but now, experts are trying to see if they can track—and possibly ease—the mind.

The Harvard School of Public Health has teamed up with Beth Israel Deaconess Medical Center’s Digital Psychiatry Program to develop apps that investigate how smartphone technology could be used for mental health treatment.

Dr. John Torous, psychiatrist and co-director of BIDMC’s Digital Psychiatry Program explained that one focus of research involves symptom monitoring.

In order to determine if spikes or changes in behavior relate to future or developing symptoms, “The Harvard School of Public Health developed an app that collects passive data that can monitor GPS, accelerometer, and call and text logs,” explains Torous. “We don’t know the content of your texts or who’s calling, but the app’s collecting information based on location and social habits.”

After evaluating research from an ethical standpoint, BIDMC and the School of Public Health are studying a cohort of 20 consenting schizophrenia patients using the app, which is not available in app stores. Data from the research will be used to determine if the logged behavioral information correlates to changes in their mental health. “We’re seeing if we can use this information to better understand when people are at risk of relapse or when they should come in for a more urgent check-up appointment,” Torous explained.

BIDMC’s Digital Psychiatry Program, funded by a grant from the Myrtlewood foundation, began its work eight months ago, according to Torous. He added that they next hope to launch an app which tests cognitive behavior through gaming experiences. Users who download from the app store will only see their game scores and results. However, there would be a non-public version that monitors results just for research purposes.

“A lot of mental illnesses have a set of subtle cognitive symptoms … We’re hoping that we can have people play these mini-games on their phone, which may allow us to understand better what the cognitive symptoms of mental illness are — and if those can be useful in both predicting risk of relapse and return symptoms.”

Another mission of the Beth Israel program is to educate users about the risks and benefits of mental health apps. For Torous, benefits of this technology include accessibility and low costs of use. Because a growing amount of people are using smartphones, he said it is easier for them to find these augmented treatment strategies. However, he explained that users should consider symptoms, other potential illnesses that affect mood, privacy policies and any need for in-person treatments when they are downloading mental health apps.

Torous, who chairs the Smartphone App Evaluation task force for The American Psychiatric Association, warned that some apps may read and sell a user’s personal mental health data. Users may also run the risk of downloading an app that offers dangerously misleading information or is ineffective as a treatment.

Torous’ task force created a list of questions to consider when downloading a mental self-help app. While this questionnaire acknowledges safety, it also can be used to help users identify evidence-based apps from those with unrealistic claims.

Despite an app’s success, there still may be a struggle with user retention, according to Torous, who said that this may require a greater in-person support system or a tailored treatment plan.

“The strongest predictor of treatment retention is the bond that happens between the patient and the therapist. It’s unclear how well we can replicate that human connection between the therapist and a patient. There are good cases that it’s been done, but it’s tricky to develop that relationship,” Torous expanded.

One potential retention strategy for mental health applications combines short activities with light guidance, according to Torous, who pointed to a recent Northeastern University Chicago study which observed the use of “mini-apps” and mild counseling. Over 90 percent of participants in the eight-week study, funded by the National Institutes for Mental Health, continued using their assigned mini-app for the duration of research. A mini-app, in this research, is described as a non-time consuming app meant to be used for shorter periods than normal apps on the market.

Author and Assistant Professor of Preventative Health Stephen Schueller, PhD., said in a phone interview, that the mini apps ask for a variety of small tasks or cognitive behavioral tests for different mental health disorders, such as depression.

The suite of mini apps, called “Intellicare” used in a study published in January’s Journal of Internet Research, is available in the Google Store. Schueller says one of the suite’s top downloads is an app called Daily Feats. Users open the app and answer a short symptom questionnaire. Depending on the level of depression marked by the questionnaire, a user is given a tailored to-do list of realistic, healthy tasks. If they mark these tasks as completed daily, the app will keep track of their task completion streak.

“We see that usage [of mental health smartphone apps] drops considerably after the first week. It’s hard to keep up that burst of motivation that people have when they start using an app. We actually had very consistent usage of our apps across the eight weeks of our study,” he explained.

Cognitive tests or tasks in the Intellicare app suite took roughly one minute each day. Users also received a coach who called them for a 30-minute introduction and later texted them two to three times a week to track progress.

“People used the apps about 20 times per week. One of the reasons I think that’s true is that our apps have a much smaller threshold for use. They’re really modeled after the apps we have on our phones where you can open them up, do something quickly and close it,” Schueller added.

In the next steps of research, Schueller hopes to create a recommendation system for this suite of mini-apps, similarly to how Netflix works for video by telling the user which other apps they may benefit from using.

Torous, who also noted the research explaining low retention rates of mental health apps following one week, said users in the ongoing schizophrenia study, are only asked to do short tasks with the app each day, such as filling out a short form about their symptoms. They are also told to continue seeing their therapist or doctor regularly.

Although the effectiveness of digital mental health strategies is still being researched, Torous and Schueller similarly said that they believe these tools will continue to exist and evolve in the future.

“Probably about one in five people who experience mental illness are getting treatment and there’s lots of people who are not quite meeting diagnostic status … We should have a portfolio of available resources out there. There should be face-to-face treatment, peer support, and technology-based intervention.”

Both agreed, however, that current users should be realistic about self-help and mental health apps capabilities.

Schueller explained, “My biggest fear with mental health apps is that people will download an app and not get better and then say ‘I tried mental health and it didn’t work.’ If people really need help, I encourage them to find something that is helpful to them.”

“If anyone tells you this stuff is a fantasia, they’re probably trying to pull your leg. Like anything, there’s risks and benefits,” Torous said.

Pamela Bump

Pamela Bump

    Pamela Bump is a candidate for the Master of Science in Media Ventures at Boston University. After receiving a B.A. for a dual major in Journalism and Communication Studies from Keene State College in 2014, she became the Web Editor and Social Media Expert at Taste for Life Magazine, an alternative health publication. She then served as Copy Editor at The Keene Sentinel, a daily newspaper in Keene, N.H. While editing daily city news and designing pages for print, she also managed, edited, and contributed to a weekly health section.As a Media Ventures student with a passion for health journalism, Pamela hopes to use her time at MedTech to expand storytelling skills, while learning about leadership and innovation in the media-startup industry.

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