Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials

Firth, Joseph; Torous, John; Nicholas, Jennifer; Carney, Rebekah; Rosenbaum, Simon; Sarris, Jerome

doi:10.1016/j.jad.2017.04.046

Cited by 643 publications

(466 citation statements)

References 31 publications

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“…With meta-analyses suggesting benefits of smartphone apps for conditions like depression5 and anxiety,6 one might expect apps to be commonly used clinical tools. In reality, the clinical uptake and utilisation of these smartphone apps remains limited, despite the tremendous clinical potential, interest and early supporting evidence.…”

Section: Introductionmentioning

confidence: 99%

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

Torous

Nicholas

Larsen

et al. 2018

Evid Based Mental Health

Self Cite

621

447

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The potential of smartphone apps to improve quality and increase access to mental health care is increasingly clear. Yet even in the current global mental health crisis, real-world uptake of smartphone apps by clinics or consumers remains low. To understand this dichotomy, this paper reviews current challenges surrounding user engagement with mental health smartphone apps. While smartphone engagement metrics and reporting remains heterogeneous in the literature, focusing on themes offers a framework to identify underlying trends. These themes suggest that apps are not designed with service users in mind, do not solve problems users care most about, do not respect privacy, are not seen as trustworthy and are unhelpful in emergencies. Respecting these current issues surrounding mental health app engagement, we propose several solutions and highlight successful examples of mental health apps with high engagement. Further research is necessary to better characterise engagement with mental health apps and identify best practices for design, testing and implementation.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

Torous

Nicholas

Larsen

et al. 2018

Evid Based Mental Health

Self Cite

621

447

View full text Add to dashboard Cite

show abstract

“…As we have progressed into the digital age, the provision of health and social care services have moved towards online models, which widely reported increases in access across a wide variety of patient and caregiver groups [24][25][26]. Digital platforms that provide support for mental health have also proven to be successful and cost effective [27][28][29][30] as they offer flexible accessibility, inclusivity, and anonymity which can be appreciated in a stigmatized mental health context [31]. Therefore, we aimed to develop an online version of the REACT booklet.…”

Section: Digital As a Vehicle For Providing Supportmentioning

confidence: 99%

A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach (Preprint)

Honary¹,

Fisher²,

McNaney³

et al. 2018

Preprint

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Background: Relatives of people experiencing bipolar mood episodes or psychosis, face a multitude of challenges (e.g. social isolation, limited coping strategies, issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, in order to design tools that are useful to relatives, we first need to understand their needs.

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“…Responding to the urgent need to provide more people with access to effective treatments, substantial research has been undertaken on the use of technology to increase access to mental health treatment [3][4][5][6][7][8]. Much of this work has focused on the development and evaluation of computerised Cognitive Behavioural Therapy (CBT) [5,[8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…With 76% of UK and 81% of US adults owning a smartphone [15,16], there is a strong argument for the potential of apps to help in providing flexible access to mental health support [17,18]. Studies have been conducted focusing on the development of mobile apps to support mental health [19][20][21][22][23][24][25][26][27][28] and more detailed reviews and analyses of existing research are also available [4,[29][30][31]. This work indicates the potential of appropriately designed apps and could drive future innovation in mental health apps to ultimately deliver large-scale impact on public health.…”

Section: Introductionmentioning

confidence: 99%

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews (Preprint)

Stawarz¹,

Preist²,

Tallon³

et al. 2018

Preprint

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Abstract:Background: Hundreds of mental health apps are available to the general public. With increasing pressures on healthcare systems they offer a potential way for people to support their mental health and wellbeing. However, while many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited. Objective: The aim of this paper was to analyse functionality and user opinions of apps purporting to support Cognitive Behavioural Therapy (CBT) for depression and to explore key factors that have impact on user experience and support engagement. Methods: We systematically identified apps described as being based on CBT for depression. We then conducted two studies. In the first, we analysed the therapeutic functionality of apps. This partially replicated existing work on apps' fidelity to CBT theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in CBT apps for depression were compared with those found in a larger group of apps that support mental wellbeing in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of CBT apps for depression. Results: We identified 31 apps that purport to be based on CBT for depression. Functionality analysis (Study 1) showed that they offered an eclectic mix of features, including many not based on CBT practice. CBT apps used less varied engagement features compared to 253 other mental wellbeing apps. The analysis of 1,287 user reviews of CBT apps for depression (Study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to take active role in supporting their mental health and wellbeing. Users, including health professionals, valued and used apps that incorporated both core CBT and non-CBT elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, e.g. in the context of automatic thoughts, users express a preference to capture not just negative, but also positive ones. Privacy, security and trust were crucial to the user experience. Conclusions: CBT apps for depression need to do a better job of incorporating evidencebased CBT elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidencebased strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance between evidence-based CBT strategies and evidence-based design strategies, including the possibility of eclectic therapeutic techniques.

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Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials

Cited by 643 publications

References 31 publications

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach (Preprint)

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews (Preprint)

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