Technology has opened a new frontier in mental health support and data collection. Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing.
Mobile mental health support can be very simple but effective. For example, anyone with the ability to send a text message can contact a crisis center. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs. Some apps are stand-alone programs that promise to improve memory or thinking skills. Others help the user connect to a peer counselor or to a health care professional.
Excitement about the huge range of opportunities has led to a burst of app development. There are thousands of mental health apps available in iTunes and Android app stores, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead consumers to wonder which apps they should trust.
Before focusing on the state of the science and where it may lead, it’s important to look at the advantages and disadvantages of expanding mental health treatment and research into a mobile world.
Experts believe that technology has a lot of potential for clients and clinicians alike. A few of the advantages of mobile care include:
This new era of mental health technology offers great opportunities but also raises a number of concerns. Tackling potential problems will be an important part of making sure new apps provide benefits without causing harm. That is why the mental health community and software developers are focusing on:
Creative research and engineering teams are combining their skills to address a wide range of mental health concerns. Some popular areas of app development include:
“Self-management” means that the user puts information into the app so that the app can provide feedback. For example, the user might set up medication reminders, or use the app to develop tools for managing stress, anxiety, or sleep problems. Some software can use additional equipment to track heart rate, breathing patterns, blood pressure, etc. and may help the user track progress and receive feedback.
Apps that help the user with cognitive remediation (improved thinking skills) are promising. These apps are often targeted toward people with serious mental illnesses.
Skill-training apps may feel more like games than other mental health apps as they help users learn new coping or thinking skills. The user might watch an educational video about anxiety management or the importance of social support. Next, the user might pick some new strategies to try and then use the app to track how often those new skills are practiced.
This type of app technology adds additional support by allowing the user to interact with another human being. The app may help the user connect with peer support or may send information to a trained health care provider who can offer guidance and therapy options. Researchers are working to learn how much human interaction people need for app-based treatments to be effective.
A lot of effort is going into developing apps that can collect data using the sensors built into smartphones. These sensors can record movement patterns, social interactions (such as the number of texts and phone calls), behavior at different times of the day, vocal tone and speed, and more. In the future, apps may be able to analyze these data to determine the user’s real-time state of mind. Such apps may be able to recognize changes in behavior patterns that signal a mood episode such as mania, depression, or psychosis before it occurs. An app may not replace a mental health professional, but it may be able to alert caregivers when a client needs additional attention. The goal is to create apps that support a range of users, including those with serious mental illnesses.
Data collection apps can gather data without any help from the user. Receiving information from a large number of individuals at the same time can increase researchers’ understanding of mental health and help them develop better interventions.
Dr. Patricia Areán’s pioneering BRIGHTEN study, showed that research via smartphone app is already a reality. The BRIGHTEN study was remarkable because it used technology to both deliver treatment interventions and also to actually conduct the research trial. In other words, the research team used technology to recruit, screen, enroll, treat, and assess participants. BRIGHTEN was especially exciting because the study showed that technology can be an efficient way to pilot test promising new treatments, and that those treatments need to be engaging.
Researchers have found that interventions are most effective when people like them, are engaged, and want to continue using them. Behavioral health apps will need to combine the engineers’ skills for making an app easy to use and entertaining with the clinician’s skills for providing effective treatment options.
Researchers and software engineers are developing and testing apps that do everything from managing medications to teaching coping skills to predicting when someone may need more emotional help. Intervention apps may help someone give up smoking, manage symptoms, or overcome anxiety, depression, post-traumatic stress disorder (PTSD), or insomnia. While the apps are becoming more appealing and user-friendly, there still isn’t a lot of information on their effectiveness.
There are no review boards, checklists, or widely accepted rules for choosing a mental health app. Most apps do not have peer-reviewed research to support their claims, and it is unlikely that every mental health app will go through a randomized, controlled research trial to test effectiveness. One reason is that testing is a slow process and technology evolves quickly. By the time an app has been put through rigorous scientific testing, the original technology may be outdated.
Currently, there are no national standards for evaluating the effectiveness of the hundreds of mental health apps that are available. Consumers should be cautious about trusting a program. However, there are a few suggestions for finding an app that may work for you:
Between FY2009 and FY2015, NIMH awarded 404 grants totaling 445 million for technology-enhanced mental health intervention grants. These grants were for studies of computer-based interventions designed to prevent or treat mental health disorders.
NIMH staff actively review and evaluate research grants related to technology. In recent years, these grants focused on:
In addition, NIMH created the National Advisory Mental Health Council Workgroup on Opportunities and Challenges of Developing Information Technologies on Behavioral and Social Science Research to track and guide the cutting edge of this rapidly-changing area. In 2017, the workgroup released a report reviewing the opportunities for—and the challenges of—using new information technologies to study human behaviors relevant to the NIMH mission. NIMH’s interest in this area of research was further highlighted in a 2018 notice identifying research on digital health technology to advance the assessment, detection, prevention, treatment, and delivery of services for mental health conditions as a high-priority area for the Institute.
Recently, there has been increased interest in:
You can get involved in app research. Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat diseases and conditions. Treatments might be new technology, therapies, drugs, or combinations of drugs, or new ways to use existing treatments. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Learn more about participating in a clinical trial.
To find new clinical trials involving mental health technology:
Last Revised: February 2017
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