It’s safe to say that digital treatment is here to stay. Therapy applications were already gaining traction among people dealing with issues ranging from stress to serious mental disease when the COVID-19 epidemic struck.
When offices turned virtual, they carved out a niche for themselves in the mental health industry.
While some applications, like Talkspace and Betterhelp, connect you with a competent therapist, many others have gone entirely humanless.
Mood trackers remind bipolar illness sufferers to keep track of their moods, and apps for treating PTSD promise to help people get over acute episodes by guiding them through deep breathing exercises.
The new technology may help individuals who lack access to regular mental health care recognise and manage symptoms.
This is a major benefit, according to Jason Moehringer, clinical director of ClearView Communities, a residential treatment facility for persons with serious mental illness, and co-founder of PsyberGuide, a website that gives evidence-based assessments of mental health apps.
Apps have numerous advantages over traditional therapy: they’re typically less expensive and don’t require an office visit. Some applications may assist treat mental illness, according to studies.
Experts are concerned, however, about the fast-expanding and uncontrolled market for these programs.
Users are forced to negotiate an explosion of alternatives that range from expert-recommended to possibly hazardous due to the lack of a regulatory authority actively assessing mental health applications.
“Many claims are made that may or may not correctly represent what these products truly offer,” adds Moehringer.
The “Psyber” Explosion
Torous, an associate professor of psychiatry at Harvard Medical School, says the market for mental health apps (mHealth) has grown rapidly.
Mental health apps have been around as long as the devices that provide them, but their number and popularity soared in 2016.
According to the American Psychological Association, there are between 10,000 and 20,000 mental health applications accessible today.
Torous adds that the COVID-19 epidemic has certainly given the market a lift. Americans have been increasingly open to the concept of utilizing technology to manage their health during the last year.
Despite the newfound popularity and accessibility of mHealth applications, not all mental health practitioners are on board with their use.
When correctly developed, these technologies are demonstrated to improve the mental health and wellness of their users.
In 2017, Torous and an international team of psychologists gathered data on 22 different smartphone apps.
The data they obtained came from randomised controlled trials, where people are randomly allocated to one of two groups: treated or not.
Overall, the smartphone apps they tested made users feel less sad, according to research published in World Psychiatry.
Similar findings have been reported in other studies. Apps for mental health can help people feel less nervous, lessen symptoms of schizophrenia, and even quit smoking.
Some of the research Torous and his colleagues looked at suggested that mHealth apps might be as good as or better than in-person therapy, but Torous advised caution.
According to research released after 2017, these apps function best when used in conjunction with in-person treatment.
He also points out that these clinical trials aren’t completely applicable to the ordinary app user’s experience.
Participants in a clinical study, for example, may be more motivated to engage in a mHealth therapy program.
In comparison, the average user keeps a mHealth app for about two weeks, according to Torous.
People who require additional hands-on therapy are directed to in-person counselling using mHealth.
Colleen Stiles-Shields, a professor of psychiatry at Rush University Medical Center, says, “It can provide such a great foot in the door.”
After all, seeking mental health treatment still has a stigma attached to it. An app can be a simple and unobtrusive first step.
There’s a catch: compared to the vast number of mental health applications available, the number of apps evaluated by scientists is insignificant.
It’s also nearly impossible to tell what’s real from what isn’t.
The digital health app “Wild West”
In the United States, mHealth applications that give treatment recommendations are classified as medical devices.
FDA is the U.S. Food and Drug Administration (FDA).
However, since the FDA has “regulatory discretion” over mHealth applications, app developers can make therapeutic claims without FDA approval.
The FDA is not actively monitoring the mHealth industry because to the low risks associated with its use.
If the FDA learns of a hazardous app, it can remove it from the app stores.
The sheer amount of apps and the FDA’s limited capacity means many apps make false claims and get away with it, Torous contends.
In a text message, he said, “No one appears to be investigating the validity of their claims.”
An multinational team of psychologists examined 52 anxiety apps and found that 67% were built without medical advice.
In a second examination of anxiety apps, researchers revealed that none of the top 25 applications contained any evidence-based therapy material.
According to Moehringer, anyone may create and promote one of these apps.
“It can be difficult for specialists to discern the difference at times, let alone potential customers searching for relief,” he says.
Some of the suggestions made by these applications are simply dangerous.
According to a 2015 Journal of Medical Internet Research assessment, one bipolar disorder app advised users to “drink a shot of powerful liquor” to help them fall asleep.
“Sometimes bipolar disorder might spread to another relative if they spend too much time with you and listen to your sad life,” according to another app.
Torous is likewise concerned about the security of his data. According to Torous, many mHealth applications capture sensitive mental-health data to sell for ad income.
“The unknown is the greatest possible risk. What will become of your data in the future? ” he declares.
In 2020, hackers threatened 30,000 current and past patients of the mental health clinic Vastaamo, threatening to disclose their therapy notes unless they paid a ransom.
Torous is concerned that data from mHealth apps could be exposed in the same way.
Moehringer joined the non-profit Psyberguide in 2012, which provides objective and evidence-based reviews of mobile health apps.
He and two other psychologists searched the app store for mHealth apps to assess, looking for data privacy, expert consultation, and evidence-based material.
It was a difficult job at times. He was reviewing hundreds of apps and was well aware that his contribution was insignificant.
The organization lacked the resources to keep up with technological advancements.
Experts say Psyberguide continues to churn, but not quickly enough to include a comprehensive and up-to-date portrait of the market.
Torous believes that mHealth apps will never be able to completely replace therapy.
The majority of individuals would prefer to meet with a mental health expert in person rather than using these applications.
Torous, however, advises caution when it comes to app selection.
Mindapps.org, for example, provides information on hundreds of apps, including data privacy.
According to Torous, users should avoid doing internet research to determine an app’s performance.
“It’s becoming increasingly difficult to determine whether or not an app is effective,” he says.
Furthermore, he claims that many app developers do their research, creating a conflict of interest.
Instead, he advises consulting a medical expert, such as a physician or a psychologist, to see what they suggest.
At the absolute least, a professional may examine the app to ensure that it adheres to evidence-based practices.
Moehringer believes that app shops or government regulators should index and regulate mHealth apps, not small charities.
Marketplaces may require app makers to verify claims about mental health or wellness, he says.
They could, at the absolute least, compel developers to operate under the supervision of a licensed expert.
That, according to Moehringer, is unlikely to happen anytime soon.
Most health applications would almost definitely be eliminated if regulations were enacted, while development costs would skyrocket.
As a result, he claims, the FDA is under pressure to remain out of the app industry.
A smaller market with a greater barrier to entry for developers, according to Moehringer, would be beneficial.
“All types of medical procedures are monitored by numerous boards,” he says.
“I don’t see why that model couldn’t be used here as well.”