‘Psychotherapy’ apps: Be mindful of usability, clinical orientation

While the benefits of mobile apps can be revolutionary in clinical settings, not all that glimmers is gold. Many “psychotherapy” apps are developed by companies and individuals who are not trained in any of the behavioral sciences. These apps show a distinct lack of understanding of clinical processes, making them questionable for use in a behavioral healthcare office.

Further, many apps have no validity. If validity is mentioned at all, it may be in a claim for the validity of the underlying theory upon which they are constructed (e.g., cognitive behavior therapy, mindfulness, dialectic behavior therapy). The app itself may have not been subjected to research to determine whether it is valid. Many such apps therefore may have visual or other superficial appeal, but are not clinically useful. They may also pose other risks, such as not being secure and HIPAA-compliant when needed.

When considering the implementation of a mobile app, here are two criteria behavioral healthcare providers should keep in mind:

Usability. While app usability is a broad concept, it basically refers to the design and functionality of the software involved—how easily it works, as well as whether it has clear instructions, makes intuitive sense, is free from bugs and doesn't unnecessarily drain the device's power. If a smartphone app has too many navigational buttons (more than three or four across the bottom), the app design itself may lead to a high data input error rate, which will frustrate users. Narrow buttons can be missed by people who have large fingers or are manipulating the app quickly. Agencies and clinicians, then, need to know which apps are well constructed. Reading an app's reviews in an app store can help with such determinations, but it’s worth noting that app reviews can be notoriously skewed by people who are paid to post positive comments. Carefully review negative comments to look for usability issues in these cases. Negative comments can also include suggestions for other apps, which may also be worth investigating.

Clinical orientation. Many apps are also mislabeled, being narrowly focused on a particular clinical orientation but claiming to offer assistance for general issues. The lack of clear labeling and/or discussion of clinical orientation can quickly render many apps confusing or useless to clients/patients who see a clinician from a differing orientation. Even if an app is evidence-based, well-constructed, affordable and easy to use, it may be that a CBT app that isn't useful to a client/patient who is undergoing treatment for multiple addictions. While some aspects of the CBT app may be relevant, other aspects can be directly contradictory to practical or theoretical positions taken by addiction treatment. Matching apps to the therapy then, can be an issue, particularly when a clinician isn't familiar with the types of apps that are most appropriate for the type of treatment being delivered.

These issues have been of such interest to clinicians that the American Psychological Association (APA) in collaboration with the Coalition for Technology in Behavioral Science (CTiBS) sponsored a free webinar in May, which can still be accessed. A recent APA Monitor article on the topic was also published.