Apps aren’t always apt for mental healthcare
WHEN I was an undergraduate, I was delighted to show one of my lecturers some research extolling the virtues of coffee as a healthy way to boost concentration. At the time, I drank at least four or five cups a day and was convinced it helped my productivity. My lecturer, who had a fondness for green tea, had warned me against drinking so much coffee.
With research study in hand, I was all ready to show him. Science had my back – he could keep his green tea! Alas, the hubris was shortlived. My lecturer – a journalist of 30 years and still going – asked, “Did you check who sponsored the research?”
Sure enough, the study was backed by a beverage company that happened to be pushing a new coffee product. It was part of the PR campaign, and “research says” is among the powerful phrases that instilled confidence in products then – and it still is today.
“Whenever something seems too good to be true, always check to see who’s selling the story.” It was sound advice, even if it did put a sizeable dent in my ego.
Over the past year, the mental health industry has seen a spike in demand for services, particularly tech-based apps offering counselling and psychotherapy. I’ve been asked a number of times whether these apps are effective, and what benefits they provide.
According to Prof Bruce Wam-pold, one of the crucial ingredients of effective therapy is the relationship between therapists and their clients. Prof Wampold is Emeritus Professor of Counselling Psychology at the University of Wisconsin-madison in the United States and has spent the past 40 years studying what makes therapy work.
Counselling, fundamentally, is when two or more people work together to understand each other and the issues at hand. It’s a collaboration built on connection, rapport and trust. When he trains therapists to develop an effective practice, Prof Wampold focuses on six core skills, all of which rely on building and maintaining a strong therapist-client relationship.
Sometimes, we see mental health apps list a number of benefits including the convenience of not having to attend counselling in person – people can receive help from the comfort of their homes on their devices.
This could certainly benefit those who are unable to attend physical sessions or live in areas where mental health services aren’t easily accessible. But it can also lead to less effective therapy and promote isolation and avoidance behaviours. For example, someone with anxiety might feel good about using a textbased therapy app. They needn’t leave the house or interact in realtime with someone they can see and hear. Using the app might make them feel safe; however, by avoiding leaving the house and interacting with others, this can potentially make the anxiety worse not better.
Effective therapy should include making clients feel safe – but as Prof Wampold suggests, it also requires clients to examine or engage with parts of themselves that can be initially difficult and uncomfortable to confront. In my opinion, if clients are always feeling good and unchallenged in therapy (that is, they’re not inclined to make some change during the process), they might be paying for a supportive friend rather than an effective therapist.
As for mental health apps, evidence for their effectiveness remains thin on the ground. Some apps claim that they are more effective than in-person therapy, for which there appears no evidence. There are also claims that they are “just as effective” as in-person therapy, and there seems to be very little evidence to support this.
One common claim is that using mental health apps is “better than nothing”, but this is a vague claim at best. If a person has clinical depression, spending time each day walking in the sun and doing exercises is better than nothing – but this is not a strong line of argument.
Dr Chua Sook Ning – Harvard visiting scholar and founder of mental health organisation Relate Malaysia – suggests that mental health apps can be useful as supplemental aids to conventional treatments rather than standalone alternatives.
She says that “Technology doesn’t take the place of actual human interaction. Two main reasons why psychotherapy works is because it’s based on solid psychological principles of how people function and the relationship between the therapist and the client.
“Mental health apps might be helpful, just as some books are helpful to read – it depends on your needs. If you are fairly healthy, have good social support and you just need a little more assistance, reading a self-help book might be sufficient.
“If you need more support, as it stands, there is little evidence mental health apps alone will be sufficient.”
According to those with professional backgrounds in psychology or mental healthcare, using mental health apps offers some benefits as supplemental treatment, but we’re quite a way off from apps being able to provide the therapeutic benefits of proper human interaction.
It’s understandable that those who develop such apps will focus on selling people on the benefits, but when in doubt, it’s always best to check who’s selling the story.
Sandy Clarke has long held an interest in emotions, mental health, mindfulness and meditation. He believes the more we understand ourselves and each other, the better societies we can create. If you have any questions or comments, email lifestyle@thestar.com.my. The views expressed here are entirely the writer’s own.