When to appeal for help

There is no replacement for a therapist, but therapy apps have their place, writes

YKaren Nimmo.

our mood is low, you are irritable and wound up and you are sleeping badly. You are also struggling to balance your postpandemic flexi-work arrangements with your frenetic home life.

Weekends don’t feel fun any more and you have lost interest in getting on your mountainbike, hanging out with friends or even going for a walk. You have reached out for therapy but there are long waitlists for appointments. It will take months to see someone and it is expensive.

A friend suggests trying a mobile therapy app, but you are reluctant to put anything more on the to-do list and you are a little cynical. Your phone as a therapist? Do these apps even work?

Therapy is a click away

Mobile mental health apps are a boom industry, said to be growing at between 20% and 32% each year, and offering a dizzying array of options.

It is estimated 20,000 such apps exist and many make big claims–that they work for depression, anxiety, phobias, PTSD, sleep problems, eating disorders, smoking and alcohol use, and all kinds of stress.

But do they work? Research has a foot in both camps. Though some evidence supports the use of smartphone-based apps for mental health, there is debate around their efficacy.

A study published in Harvard Health that surveyed mobile app interventions across almost 50,000 patients found no ‘‘convincing evidence’’ that any app greatly improved outcomes related to anxiety, depression, smoking or drinking, suicidal thoughts or general wellbeing. However, they conceded outcomes may have been influenced by the study methods used.

Mobile apps offer some obvious benefits: they are cheap (many are free), accessible and convenient – as easy as pulling out your smartphone. If you are struggling at midnight or the weekend, they are there; if you are travelling, they go with you.

Like many therapists, I support the use of evidence-based apps – for the people at a mild level of mental/emotional difficulty.

They can be a helpful supplement to therapy, providing practical strategies– such as breathing techniques, soothing sounds, meditation and mindfulness strategies – and are useful additions to your psychological toolkit.

Clients have said apps have helped them through a rough day and kept them on track with daily reminders and practical exercises. Others use them to get to sleep – to the sound of rain, ocean waves or soothing voices.

They can also serve to gather personal data by tracking mood changes and increase awareness of stress triggers and symptoms.

The affordability is hugely attractive.as the cost of living continues to soar, it is hard to justify seeing a therapist when you are struggling to pay the grocery bill.

But mobile apps are still in their infancy and they are no replacement for a trained mental health clinician, especially when someone has moderate to severe difficulties such as depression, PTSD or suicidal thoughts.

As good as an app might be, it can’t combine all the pieces of your story to make an accurate diagnosis.

It can’t personalise your treatment or write you an adequate safety plan. An app might assign you some homework, but it is not going to care if you do it or not. There is also limited data on the longer-term benefits – whether the tools people learn will stick over time, or whether the gains come from continuous use.

Perhaps the biggest difference from therapy is that apps remove the human element: having someone listen to your story is a crucial factor in mental health improvement.

Many studies have shown a sound, trusting relationship between therapist and client to be the key ingredient in moving forward.

For someone who is struggling, the benefits can come from feeling safe and heard, knowing someone ‘‘gets’’ you and your perspective, that they’re fully in your corner.

Therapy can also be helpful – and mentally healthy – in that people put their phones away for an hour, shut out the noise, and have rare time to themselves.

Clients will often say ‘‘It’s such a treat to be able to just focus on myself. It’s me time.’’ But it’s more than that – it’s about having someone validate your story, provide feedback and possibly guidance about how to do things differently.

Apps can help

Perhaps the biggest difference from therapy is that apps remove the human element: having someone listen to your story is a crucial factor in mental health improvement.

Apps have their place in mental health support. If you are interested, research the app’s evidence base (is the approach based on recognised psychological models such as Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy (ACT), ease of usability and security/privacy features. Apps such as Calm, Headspace and Moodfit are popular, but there is plenty of choice – check out reviews.

And remember the adage that applies to every form of medical intervention, not just mental health. That is, treatment has better outcomes when the person using it believes it will help.