How to choose the right psychotherapy apps

More than 165,000 health-related apps now exist, and many agencies and clinicians are considering the use of apps as an affordable and convenient way to enhance the care they provide.

Behavioral providers have reported the use of apps to augment clinical care for specific purposes ranging from serving as "transitional objects" in psychodynamic approaches to encouraging clients/patients to conveniently record information about their own behavior in real time. Many apps automatically produce graphs, charts and other aids that help the user understand and modify their behavior.

Certain health tracking apps familiar to smartphone users, such as step counters, can provide basic data that patients can then share with their practitioners, allowing the focus of a clinical session to shift to associated cognitions, behaviors, support systems and more.

Clinicians can also encourage their patients to use more specific apps that provide data related to items such as sleep, eating disorders, exercising, addictions, medication adherence and mood tracking. Data collected by such apps can be shared with the clinician either during an in-office visit or by electronic communication between sessions.

When assigning the use of a specific app to a patient, clinicians should be sure to:

• Explain how the app works, as well as its purpose and functionality
• Assist with installation
• Make sure the app’s settings are properly calibrated

Considering behavioral app review criteria

While several groups have identified app review criteria for the behavioral field, none have been widely adopted, and most professionals are unaware that they exist. Nonetheless, progress is being made in this area.

Agency administrators and clinicians are encouraged to use apps, but to weigh their respective benefits and limitations. In many settings, assigning optimal app selection to a small group of clinicians is warranted. Building feedback mechanisms into this decision-making processes is also wise, thereby allowing the committee to review regular reports regarding the effectiveness of selected apps.

Safe apps to use

The National Center for Telehealth and Technology (T2) is a federally funded program that creates and disseminates free, evidence-based apps that are safe to use with behavioral populations. An example is the T2 Mood Tracker, a mobile application that allows users to monitor emotional health. Originally developed as a tool for service members to easily record and review their behavior changes, particularly after combat deployments, this app has become popular with civilian users around the world. 

Many worthwhile apps have been created by researchers at government funding agencies or academic institutions, which demand rigor regarding app development and validation.

Responsible clinicians are encouraged need to make judicious use of objective review criteria before proceeding. To help with such decisions, we recommend the following resources:

• Criteria published in a book titled mHealth Applications ("Apps") for Psychologists (Maheu, Pulier and Roy, 2013)
• A 2013 study led by University of New South Wales psychologist Tara Donker, PhD, who examined the usefulness of apps for self-help for mental health concerns and disorders (Journal of Medical Internet Research, 2013)
• A 2015 meta-analysis led by Harvard Medical School psychiatrist John Torous, MD (Internet Interventions, 2015)

A more recent effort at examining app review criteria is currently being published by Springer Health in the Journal of Technology and the Behavioral Sciences (Maheu, Nicolucci, Pulier, Wall, Hudlick & Frye, pending). 

References 

Maheu, M., Pulier, M. (2013). mHealth Applications ("Apps") for Psychologists, In G. Koocher, J. Norcross, & B. Greene (Eds.), Psychologist's Desk Reference (3rd edition), New York, Oxford University Press Publication.

Maheu, M., Nicolucci, V., Pulier, M., Wall, K., Hudlick, E., Frye, T. (pending). The Interactive Mobile App Review Toolkit (IMART): A clinical practice-oriented system. Journal of Technology and the Behavioral Sciences.